Oral
Answers to
Questions

Foreign, Commonwealth and Development Office

The Secretary of State was asked—

Ukraine: British Diplomatic Support

Claire Coutinho: What assessment she has made of the effectiveness of British diplomatic support for Ukraine.

Robbie Moore: What assessment she has made of the effectiveness of British diplomatic support for Ukraine.

Sheryll Murray: What assessment she has made of the effectiveness of British diplomatic support for Ukraine.

James Cleverly: The UK has been steadfast in its diplomatic support for Ukraine in the face of Russian aggression. My right hon. Friend the Prime Minister travelled to Kyiv on 17 June to meet once again with President Zelensky. They discussed the situation on the ground, and the Prime Minister announced a major training programme for the Ukrainian armed forces to help sustain them in their heroic defence of their people and their homeland. The United Kingdom will continue to strengthen the hand of our Ukrainian friends to finish the war on terms that President Zelensky has laid out.

Claire Coutinho: I commend the Secretary of State, the Prime Minister and the entire team for all their work on diplomacy in Ukraine. We can all be very proud of it. I was pleased to see that the leaders discussed ending the blockade of grain in the south. Will the Minister update the House on how those discussions went?

James Cleverly: The House, and indeed the whole world, should be under no illusion: it is Russia that is blocking Ukraine’s grain exports in an attempt to cripple Ukraine’s economy and use hunger as political leverage. We support the United Nations’ efforts to negotiate a safe corridor for exports by sea and we are engaging internationally to call on Russia to end the blockade. Only Russia can lift the blockade. Ukraine’s ports are vital for global food supplies, and we will keep supplying the weapons that Ukraine needs to bring the war to a successful conclusion.

Robbie Moore: Last Sunday afternoon, I spent a couple of hours meeting a Ukrainian family who have moved to the Worth valley in my constituency under the Homes for Ukraine scheme. They are so incredibly grateful for the work that the Government are doing, but they did reiterate that we cannot rest until full Ukrainian sovereignty and territorial integrity is restored in Ukraine and until Putin fails. Will my right hon. Friend update the House on recent conversations that he has had with global allies on how we can take a co-operative approach with international partners to ensure that that happens?

James Cleverly: I thank my hon. Friend and his community for hosting Ukrainian refugees. Praise is due in every corner of the House for our constituents doing just that. I assure him that my right hon. Friend the Foreign Secretary, my right hon. Friend the Prime Minister and other Ministers in the Foreign and Commonwealth Office and other Departments, as well as officials at every level, are engaging with our international friends and allies on this issue. It will be raised at the Commonwealth Heads of Government meeting, the G7, the G20 and the NATO meeting in Madrid. I also assure him that the UK will not rest in its support of the Ukrainian Government and the Ukrainian people, and we will not rest in advocating on their behalf with the international community.

Sheryll Murray: What resources is the Department making available to assist Ukraine with prisoner of war swaps?

James Cleverly: My hon. Friend makes an incredibly important point. With your indulgence, Mr Speaker, I will reassert the position that the Ukrainian Government have confirmed. Foreign nationals fighting as members of their armed forces must be treated as prisoners of war—that includes the British nationals captured by the Russian forces—and all prisoners of war should be treated in accordance with international humanitarian law, including the Geneva convention. We will of course continue liaising with the Ukrainian Government on the treatment of prisoners of war and any negotiations they might have with Russian forces on the issue.

Andrew Gwynne: I thank the Minister for the responses he has given to hon. Members. We as a House of Commons stand united with the people of Ukraine in the face of Russian aggression. May I ask the Minister sincerely what assistance the British Government and NATO allies are giving to the people and Government of Ukraine to tackle Russian disinformation?

James Cleverly: The hon. Gentleman makes an incredibly important point. When I speak to my Ukrainian counterpart and others facing direct or indirect Russian aggression, they often bring up disinformation and cyber-attacks. This is a theatre of war, and the integrated review, which was published last year, recognises that. I assure him that we will continue working closely with our friends and allies to counter disinformation and to help them defend themselves against cyber-attack as well as physical attack.

Catherine McKinnell: All our hearts and support are with the people of Ukraine, but the conflict is having a significant impact worldwide. Particularly affected are people in east Africa, where grain shortages have coincided with the most dangerous drought in 40 years, cuts to aid and covid-19. Save the Children and Oxfam report that one person is dying of hunger every 48 seconds in Ethiopia, Kenya and Somalia. Will the Minister commit to front-loading future resilience funding to bring forward funds now to prevent a famine?

James Cleverly: The hon. Lady makes an incredibly important point. As I said in my earlier answer, Vladimir Putin is using hunger in the global south as a weapon of war and as a point of leverage. It should be noted that the 25 million tonnes of grain currently stuck in Ukraine is equivalent to the yearly consumption of the least developed countries in the world. She is absolutely right to be focused on this issue. My right hon. Friend the Foreign Secretary has said that we will prioritise our humanitarian response in future funding for the Department, but I can assure her and the House that it will remain a priority for the Government.

Tim Farron: It is very clear that Putin is indeed the using the starvation of the world’s poorest people as a tool of war. As we seek to fight back against Putin and use all diplomatic powers, does the Minister agree that it would be easier to build a coalition against Putin across the developing world in particular, and of course morally right, if we reversed the cuts to international aid or kept them?

James Cleverly: The hon. Gentleman is conflating two fundamentally different issues. The world should be clear that it is Vladimir Putin alone who is creating these problems with his blockade of grain exports from Ukraine. He could turn on the tap of food to the global south tomorrow, and we demand that he does. We will continue to work with our international partners, including the United Nations, to try to facilitate those grain exports, but the world should be clear that it is down to him and that the Russian blockade of the Black sea and Sea of Azov ports is creating that hunger. He should be held accountable for it.

Stephen Doughty: I agree with much of what the Minister has had to say. The shadow Foreign Secretary and I met a delegation of Ukrainian MPs last week and heard at first hand the devastating impact Russia’s illegal actions are having on civilians across Ukraine. May I bring the Minister back to a point I have raised with him a number of times? We need to stay the course in our support for Ukraine, and the whole world needs to stay the course with Ukraine. That will involve substantial costs. Will he look again at not only freezing Russian assets but their seizure and repurposing to ensure that we can support humanitarian and reconstruction efforts in Ukraine?

James Cleverly: The hon. Gentleman and I often disagree—that is the nature of being in different parties—but on this issue he is absolutely right that there is a unanimity of voice across the House. I can assure him that we are looking at the issue he raises on seizures and repurposing  the value of those seizures. Nothing is off the table. The pain and suffering being inflicted on the Ukrainian people by Putin and his faction must be paid for, and paid for by them.

Alyn Smith: I echo the comments that Foreign, Commonwealth and Development Office staff and the diplomatic core worldwide do a great job under difficult circumstances, but they are being undermined by talk of politically motivated appointments at home, job losses across the civil service as a whole, and the cut to the 0.7% commitment on aid, a manifesto commitment now betrayed. Surely now is the time to reverse all that talk and actually support civil servants doing tough jobs in tough times?

James Cleverly: I thank the hon. Gentleman for the praise he gives to our civil servants both here in the UK and across the world. He is absolutely right: they are doing a fantastic job. I can assure him that my right hon. Friend the Foreign Secretary and my ministerial colleagues across Government Departments liaise with them regularly. They are highly focused, highly motivated and absolutely determined to help deliver the UK’s Government priority, which is to support the Ukrainian people and support the people across the world who are being impacted by the food shortages Vladimir Putin is creating. They are doing so in a way that makes me and the whole House proud. I have no doubt that they will continue to do so.

Asadollah Assadi

Matthew Offord: If she will make representations to her Iranian counterpart on the case of Iranian diplomat, Asadollah Assadi.

James Cleverly: The UK condemns in the strongest terms the targeting of civilians and regularly raises this issue with the Government of Iran. We welcome the fact that those responsible for the plot against the conference in Paris in 2018 have been held to account. The Belgian courts have convicted four individuals, including Asadollah Assadi, who received a 20-year sentence. We continue to work with the international community to ensure that all countries, including Iran, abide by international rules and norms.

Matthew Offord: I am trying to hide my disappointment in the answer. Asadollah Assadi orchestrated a planned terrorist attack in mainland Europe that would have resulted in mass casualties, including five Members of the British Parliament, including me. At the Munich security conference earlier this year, the Iranian Foreign Minister, Hossein Amir Abdollahian, met his Belgian and Swedish counterparts for private talks, which included seeking a petition for the release of Assadi and others through prisoner swaps. It would have been ironic if those of us who oppose the joint comprehensive plan of action had been victims, as the terrorists were using resources that came from the sanctions. May I ask the Secretary of State again to meet with her Iranian counterpart to make it clear that any future JCPOA must ensure human rights in Iran and must ensure that terrorism activities are relinquished across the region, including those aimed at mainland Europe?

James Cleverly: I am not able to speculate on the context of bilateral talks between Iran and other countries. The UK’s position is absolutely clear: the behaviour of Iran in a whole number of areas is unacceptable. We raise this regularly, and I know that my right hon. Friend the Foreign Secretary has raised our concerns about the Iranian Government’s behaviour on numerous occasions. We will ensure that we continue to call on the Iranian Government to abide by international rules and laws and to respect human rights at every level, including the right of criticism on the international stage.

Colombia: Human Rights

Mary Foy: What recent discussions she has had with her Colombian counterpart on human rights in that country.

Vicky Ford: Colombia is an FCDO human rights priority country and UK Ministers and senior officials regularly raise human rights issue as well as specific cases of concern with the Colombian Government. Most recently, my noble Friend Lord Ahmad discussed human rights and the security situation in Colombia in his meeting with President Duque on 12 April, and I raised it with Vice-President Ramírez in February.

Mary Foy: I am sure that the Minister will join me in congratulating Colombia on electing a new Administration committed to peace and human rights under Gustavo Petro.
According to human rights groups, on 28 March the army killed several civilians in the village of Remanso, in Putumayo, with outgoing President Iván Duque later praising the attack and describing the victims as armed dissidents. Given that the Colombian military has a history of killing civilians then falsifying the record, what steps are the Government taking to ensure that a proper investigation is carried out?

Vicky Ford: We congratulate Gustavo Petro on his election as President. We look forward to working with him on many shared priorities after his inauguration in August. He has made it very clear that he is committed to the peace process with the FARC. I also congratulate Colombia on a peaceful election.

Mark Menzies: Bilateral relations between the United Kingdom and Colombia have gone from strength to strength in recent years, particularly in areas of mutual concern such as trade and investment, tackling drug crime and the environment. Will my hon. Friend assure me that we will continue that same high-level engagement with the new Colombian Administration?

Vicky Ford: My hon. Friend is absolutely right. We have very many areas of shared interest with Colombia, such as trade and the environment. Tackling drug crime is also a major issue. Colombia is a key partner to the UK and Latin America. We will continue to work closely together on a broad range of issues, and we look forward to working with the new President Petro after his inauguration in early August.

Chris Matheson: Colombia is once again the most dangerous country in the world in which to be a trade unionist, so when the Minister and the Government engage with President-elect Petro and his new Government will they ensure that the peace process, which is focused on the Government and the FARC, also includes the civil society and trade union groups on which we have perhaps taken our eye off the ball?

Vicky Ford: The hon. Member makes an important point about protecting civil society. Peace in Colombia was always going to be a difficult challenge, but we have been a leading advocate of that peace process. We will continue to prioritise support for the Colombian Government, and the new President has made it clear that he is committed to the peace process with the FARC, so we will continue to work with them.

Lindsay Hoyle: We now come to the shadow Minister, Fabian Hamilton.

Fabian Hamilton: I have just returned from Colombia as part of a delegation funded by Justice for Colombia, details of which will shortly be declared in the Register of Members’ Financial Interests. Gustavo Petro’s victory in Colombia’s presidential election should provide new impetus towards the full implementation of the peace agreement in that divided country, but the UK Government have sat idly by as violence against social activists and indigenous peoples has raged on across the country. As the penholder for Colombia at the United Nations, the UK has a responsibility to play its part, so will the Minister commit to changing course and working with the new Administration to finally bring this appalling violence to an end?

Vicky Ford: I absolutely refute the idea that the UK has been standing by. To date, we have spent more than £69 million through the conflict, stability and security fund. This is supporting the implementation of the peace agreement, and it has been supporting the Government’s rural developments, reintegration programmes and transitional justice mechanisms and strengthening the security and participation of communities in conflict-affected areas. We have also put in over £240 million of international climate funding in the past decade. That is helping to stabilise particularly vulnerable environmental areas by tackling environmental crime and the issues that affect local people. We will continue to prioritise that work, because stability in Colombia is vital for the whole of Latin America.

Ukraine: International Support

Anna Firth: What recent discussions she has had with her international counterparts on support for Ukraine.

Elizabeth Truss: It is vital that we continue to back Ukraine. This is about freedom and democracy in Ukraine, and it is also about freedom and democracy in Europe and across the world. That is why we are determined to provide more weapons, impose more sanctions and back Ukraine in pushing Russia out of its territory.

Anna Firth: I am pleased that my right hon. Friend mentioned sanctions. Last week she announced a new wave of sanctions, including against Patriarch Kirill, a very public and vocal supporter of Putin’s war. Can she confirm that we will continue to put pressure not just on Putin but on his supporters until Putin fails and Ukraine succeeds?

Elizabeth Truss: My hon. Friend is absolutely right. I am proud that the United Kingdom has sanctioned more individuals than any other nation. We have to keep increasing that pressure. Last week we sanctioned Patriarch Kirill, and we also sanctioned the Russian children’s rights commissioner, who has been involved in the barbaric treatment of Ukrainian children. We will continue to impose sanctions and to stop importing goods from Russia until we see Russia fully withdraw from Ukraine.

Dan Jarvis: The new head of the Army was very clear this week when he said that the UK must be
“capable of fighting alongside our allies and defeating Russia in battle.”
Does the Foreign Secretary believe that our defence capability, which is a key arm of UK foreign policy, has all the resources it needs to do that?

Elizabeth Truss: It is very true that we face a much more insecure Europe and a much more insecure world, and it is right that we are increasing defence spending. We are increasing our capabilities, particularly in areas such as cyber, but we are also making sure that we have fully trained and efficient armed services, not just to be ready but to ensure that we are training up Ukrainians, for example, and helping our allies, particularly on the eastern flank, who face that direct threat from Russia.

Geoffrey Clifton-Brown: The harvest in Ukraine is going to have to start in the next few weeks. The problem is that there are 25 million tonnes of old crop filling up all the stores, so there will be nowhere to put the new crop. It will have to be piled on the fields, and the Russians will seize it and use it as a weapon of war to buy influence around the world. What more can my right hon. Friend do to ensure that there is international passage for that grain out of Odesa and other ports?

Elizabeth Truss: We are doing all we can to secure the export of that very important grain from Ukraine. My hon. Friend is right to say that we have only a number of weeks to be able to achieve that. We are backing the UN plan, but we are also doing what we can with our allies to provide safe passage and to make sure that Odesa is fully defended. Tomorrow, I will be travelling to Turkey to talk to people there about how we could do more to get the grain out of Odesa.

Dave Doogan: Part of any diplomatic support for Ukraine must include a strategic diplomatic support package for Ukraine’s neighbours in Moldova, Romania, Bulgaria, Poland, Lithuania, Latvia and Estonia. When I spoke to the Polish Defence Secretary a couple of months ago, he detailed what he felt was a very  lonely station on the frontline beside Ukraine. Will the Foreign Secretary update us on how he may not feel that way now?

Elizabeth Truss: We are working very closely with Poland on our joint defence support, and we are working with Poland and Ukraine on helping Ukraine get NATO-standard weapons. We are also backing Poland, our Baltic state friends and others, including Moldova, particularly through NATO and the bolstering of the eastern flank. We have the NATO summit coming up next week and the UK is pushing hard for more support in the eastern area of Europe.

Sri Lanka: Human Rights

Elliot Colburn: What diplomatic steps she is taking to help address human rights concerns in Sri Lanka.

Vicky Ford: We are closely monitoring the difficult human rights situation and the lack of progress towards post-conflict accountability in Sri Lanka. It is important that the current economic situation does not distract from human rights. We urge the Sri Lankan Government to engage meaningfully with United Nations Human Rights Council resolution 46/1. We continue to raise our concerns in international forums, including by doing so at the UNHRC on 4 June.

Elliot Colburn: The economic crisis on the island has indeed led to increased militarisation in Sri Lanka. The Rajapaksa Government are falling apart and, as we speak, a draft bail-out is being asked for from the International Monetary Fund. As chair of the all-party group on Tamils, and on behalf of Tamils in Carshalton and Wallington and around the world, may I urge my hon. Friend to ensure that the UK does what it can at the IMF to ensure that any bail-out is attached to human rights conditions, similar to the GSP Plus—generalised scheme of preferences plus—arrangement, so that Tamils can have the peace and justice they have been waiting so long for?

Vicky Ford: I thank my hon. Friend for the work he does in this area. I reiterate that it is really important that the current very challenging economic situation does not distract from efforts to improve human rights. Although the articles of the IMF do allow for conditionality linked to economic policy or to tackling the balance of payments, there is no provision to impose political-linked or human rights-linked conditionality in the IMF process. Therefore, we will work with fellow members on international debt forums on a solution to the country’s debt problem, as well as continuing to lobby the Sri Lankan Government and working in other international forums on human rights.

Lindsay Hoyle: We now come to shadow Minister Catherine West.

Catherine West: Thank you very much, Mr Speaker. Later this week, Commonwealth leaders will meet in Kigali for the Commonwealth Heads of Government meeting, and  this will include Sri Lanka. We expect the Government to voice their concerns about the long-term peace and justice issues, but pressing economic matters will also threaten stability, both within Sri Lanka and in the region. Will the Government go above and beyond what the IMF is offering and recognise the role of the Commonwealth now to step into the leadership gap and support Sri Lanka’s people with access to food and medicines, by helping to bring economic stability as soon as possible to this great friend of the UK?

Vicky Ford: The hon. Lady is absolutely right to say that Sri Lanka is a great friend of the UK. Indeed, our Prime Minister spoke to his Sri Lankan counterpart on 30 May and has underlined the UK’s continuing support for the people of Sri Lanka during their economic difficulties. He has offered UK support through multilateral organisations such as the World Bank and IMF, and international forums such as the Paris Club. We have a very significant voice on international debt forums and we are working closely with Paris Club members and multilateral organisations to find solutions to the debt crisis.

Northern Ireland Protocol

Hilary Benn: What recent discussions she has with EU representatives on the adequacy of the Northern Ireland protocol.

Stephen Farry: What recent discussions she has had with (a) EU representatives and (b) the US Administration on the Northern Ireland protocol.

Elizabeth Truss: We have been clear with the EU that the Northern Ireland protocol needs to change in order to uphold the Belfast/Good Friday agreement, ensure that we have a free flow of goods from east to west, and protect the north-south relationship. Our preference is for a negotiated solution, but in the absence of the EU being willing to change the protocol, we are pressing ahead with legislation.

Hilary Benn: I am grateful for that reply, but on the Northern Ireland Protocol Bill—which, we note with interest, has not yet found a date for its Second Reading—is there any precedent where the United Kingdom has cited the legal concept of necessity for overriding a treaty that it has freely entered into? We should bear in mind that in this case not only did the Government negotiate and sign the Northern Ireland protocol, but the Prime Minister at the time described it as being
“in perfect conformity with the Good Friday agreement”—[Official Report, 19 October 2019; Vol. 666, c. 583.]

Elizabeth Truss: We are clear that our legislation is both necessary and lawful, and have published a Government legal statement laying out exactly why that is. Our priority as the United Kingdom Government is the Belfast/Good Friday agreement, and we know that the Northern Ireland protocol is undermining that agreement. We have not seen the institutions in Northern Ireland functioning since February, and we know that  the issues caused are baked into the protocol—namely the customs provisions and the VAT provisions—so we do need to change that.
As I have said, we remain open to negotiations with the EU. That is our preferred course, but they have to be willing to change the issues that are causing real problems for the people of Northern Ireland.

Stephen Farry: The business community in Northern Ireland is clear that they want to see mutually agreed solutions, and that those are the only way in which they can protect their access to the EU single market. The key ingredient in all this is trust and partnership. The Minister’s Bill is entirely counterproductive in that respect, so what is her strategy for getting back around the negotiating table with the European Union to find those mutually agreed outcomes?

Elizabeth Truss: We are very open to negotiations with the European Union, but they have to be prepared to change the protocol itself. The problems we have with customs and people in Northern Ireland not being able to access the same VAT benefits as people in Great Britain are baked into the protocol itself, and the legislation we have introduced, with green lanes and red lanes, protects the EU single market. It does not make the EU any worse off, while at the same time enabling free-flowing trade from east to west.
We need to achieve both of those things. I want to do so through negotiations, but we have been trying for 18 months; as yet, the EU have refused to change the protocol itself, and we simply cannot allow the situation to drift. We cannot allow more trade diversion, and we cannot allow the undermining of the Belfast/Good Friday agreement.

Andrew Bowie: I hear what my right hon. Friend says about negotiating. We all agree that a negotiated settlement would be the best solution, but there is no point in negotiating with somebody who does not have a mandate to agree with any of the negotiation points being put to them. Does my right hon. Friend agree that it is up to the European Commission to change the mandate of its negotiator, Commissioner Šefčovič, so we can have those negotiations and come to an agreement, and so that the people of Northern Ireland can live safe and secure in the knowledge that we are coming to an agreement on this issue?

Elizabeth Truss: My hon. Friend is absolutely right that we want a negotiated solution. We have been part of those negotiations for 18 months, but fundamentally the mandate does not allow for the solutions that will help restore the primacy of the Belfast/Good Friday agreement and get rid of the unacceptable frictions that we are seeing in east-west trade. I suggest that Opposition Members direct their calls for negotiations towards the European Union and the goal of securing a new mandate. I think that would be a better use of their time.

David Lammy: The protocol Bill introduced to this House last week breaks international law. It risks the integrity of the Good Friday agreement. It divides the UK and the European Union at a time when we should be pulling together against Putin’s war on our continent, and it risks causing new trade barriers during a cost of living crisis. It is not even enough to get  the Democratic Unionist party to commit to return to Stormont. Will the Foreign Secretary now quit posturing for Back Benchers who have lost confidence in the Prime Minister, and get back to the hard work and graft of negotiating a practical way forward?

Elizabeth Truss: I am afraid to say that nothing the right hon. Gentleman has just said is accurate. The fact is that our Bill is legal, and we have laid it out in a legal statement. We are putting forward solutions—a green lane and a red lane—that protect the EU single market as well as allowing goods to flow freely around the United Kingdom.
We are very prepared to have those negotiations with the EU, but, at present, we have a negotiating partner that is unwilling to change the issues that are causing the problem in Northern Ireland. The right hon. Gentleman should go to Northern Ireland to see the impact that is having on businesses, hauliers and traders who are facing this customs bureaucracy. It is fundamentally undermining the Good Friday agreement.

Alyn Smith: I will confess some puzzlement over this. The EU has negotiated a variety of changes to refine the protocol. There are dispute resolution mechanisms within the protocol. There has been a number of opportunities for talks. I have read this idea that the Government need to invoke necessity when there are already other ways of fixing this. That is garbage from start to finish.
In what possible sense can the Government claim that this illegal Bill, which they have brought forward but not scheduled, is a sensible way to resolve the situation when the EU is ready and open for talks? Most people in the Northern Ireland Assembly support the protocol. I counsel the Foreign Secretary that this is also a grievous miscalculation, because it has massively undermined trust at a point when trust is utterly fundamental to resolving this matter.

Elizabeth Truss: The hon. Gentleman is wrong. We have been very open to negotiations for the past 18 months, but the EU has been unwilling to change the protocol. He can read last week’s comments of Vice-President Šefčovič that these customs procedures have to remain in place. The fact is that it is the customs procedures—the bureaucracy—that is preventing trade between Northern Ireland and Great Britain. We are seeing trade diversion towards north-south trade and away from east-west trade, and it is undermining the Belfast/Good Friday agreement. That is why it is necessary that the UK Government act. The hon. Gentleman should focus his effort on getting the EU to change its negotiating mandate so that we can have a real negotiation.

Brazil: Violence against Journalists and Activists

Kerry McCarthy: What recent assessment she has made of trends in the level of violence against journalists, environmental campaigners and indigenous activists in Brazil.

Vicky Ford: I start by reflecting on the very sad disappearance of Dom Phillips and Bruno Pereira in the Amazon region of Brazil. Our thoughts are with their families. I offer  thanks to all those involved in the search and rescue operation that was trying to find them. I pay tribute to both men and their commitment to improving our understanding of the Amazon, to its peoples and to the challenges currently faced there. Both men have left a strong legacy of defending and supporting the rights of indigenous peoples in Brazil.
Attacks on environmental activists and indigenous rights defenders in Brazil have increased in recent years, and we raise that regularly with the Government.

Kerry McCarthy: I thank the Minister for that response and I echo her comments about the tragic killings of Dom Phillips and Bruno Pereira, but they are not alone. In 2020, at least 182 indigenous activists and 20 environmental campaigners were killed in Brazil. It is the relentless drive to develop the Amazon rainforest that is behind these murders. What are the Government doing to put maximum pressure on the Bolsonaro Government to reverse that trend, but also to reduce our complicity in this through our supply chains and the involvement of British companies in financing this?

Vicky Ford: We regularly engage with indigenous leaders and civil society organisations. We are in regular contact with Brazil’s national foundation for indigenous people. We are absolutely committed to defending and promoting the human rights of all and we continue to monitor very closely developments around indigenous rights in Brazil and raise concerns with the Government. We have already committed £259 million to help protect the Amazon, with £3 billion more of further funding committed at COP. We have also made it clear that trade should not be at the expense of the environment, climate commitments or, indeed, the concerns that the hon. Lady raises.

Tracey Crouch: It is thanks to journalists and environmentalists such as Dom Phillips and Bruno Pereira that record deforestation, mining and logging, predatory fishing and drug trafficking have been exposed. Dom and Bruno were not on some travel adventure in Brazil, as has been suggested; like others who have been killed over the years, they were doing their job to report on the environmental damage taking place in Brazil that ultimately impacts on us all.
Will the Government work with other international authorities to have the case investigated in a swift, transparent and independent manner, without any interference—not just to seek justice for the families of Dom and Bruno, but to protect future journalists and environmentalists in their important work?

Vicky Ford: My hon. Friend is right that the case should be investigated. We are grateful to the Brazilian authorities for their help and engagement to date. There has been very close contact between, for example, the local and national police with our embassy team on the ground. It is really important that those who committed this heinous crime are held to account.

Cat Smith: I put on the record my condolences to the family of Lancaster-born Dom Phillips. What steps is the Department taking to support Dom’s family through diplomatic means at this difficult time?

Vicky Ford: We have been in close contact with members of Dom’s family. We will continue to give consular support to them at this time and through the next processes related to this tragic event.

Rape and Sexual Violence in Conflict

Marco Longhi: What steps her Department is taking to help protect women and girls from the use of rape and sexual violence in conflict.

Elizabeth Truss: The use of rape and sexual violence in conflict is a war crime, and I have made tackling it a top priority. The UK is campaigning for it to be treated as a red line on a par with the use of chemical weapons. We will host a conference against sexual violence in November.

Marco Longhi: We have had terrible reports of rape and sexual assault by Russian troops in Ukraine. What steps is my right hon. Friend taking to ensure safe and effective evidence collection, so that those responsible can be held to account?

Elizabeth Truss: We have seen appalling reports of atrocities and the use of rape and sexual violence. We launched the Murad code earlier this year, which sets the global standard for safe evidence collecting. We have dispatched a team from the United Kingdom to the region to help with that evidence collection—by interviewing witnesses and survivors and preserving and collecting images and videos, for example.

Jim Shannon: Near Upper Committee Corridor there has been an exhibition in the last few days showing the experiences of young women and girls who have been raped and sexually abused in Myanmar, Syria and Nigeria. What the perpetrators of those awful crimes need is accountability. Can there be someone who will take the evidence and ensure those people know that some day they will go to prison, or even worse? They will receive that in the next world, but let us make sure they get it in this world.

Elizabeth Truss: Through the International Criminal Court and the work we are doing on evidence collecting, we are working to make sure that the people committing those appalling crimes are held to account—not just in Ukraine, but more widely around the world. That is one of the key aims of the conference we are hosting in November. We are also increasing our budget for women and girls development aid, specifically to tackle sexual violence.

Preet Kaur Gill: I place on the record my deepest respect for and thanks to our wonderful development and diplomatic staff, who do a fantastic job in very difficult circumstances. I visited Afghanistan this month, which was truly heart-rending. It appears that my right hon. Friend the Member for Tottenham (Mr Lammy) and I are the only British MPs to have visited. I wonder why the Foreign Secretary has failed to visit, one year since the fall of Kabul. She knows that protecting development gains for women in Afghanistan is fundamental, given that millions are facing starvation, new restrictions and the loss of livelihoods.
Rather than hosting a summit, maybe the Foreign Secretary can explain what she meant when she said that
“we are restoring the aid budget for women and girls back to its previous levels and we are also restoring the humanitarian aid budget.”—[Official Report, 8 March 2022; Vol. 710, c. 191.]
Given that she failed to give an oral statement to the House on her 10-year international development strategy, will she make a statement to the House on when she plans to reverse the £1.9 billion in aid cuts to women’s programming that have proven so damaging to women and girls and to our reputation abroad—or is she following the Prime Minister’s lead of chasing headlines and not delivering?

Elizabeth Truss: I utterly condemn the appalling actions of the Taliban in reversing women’s and girls’ rights. We are doing all we can together with our international counterparts, including hosting a pledging conference to secure more support for the people of Afghanistan. As I have said, we are restoring the women’s and girls’ budget back to £745 million a year, and we are also ensuring that the humanitarian budget is greater so that we can tackle these issues around the world.

Topical Questions

Anne McLaughlin: If she will make a statement on her departmental responsibilities.

Elizabeth Truss: This Thursday I will be heading to Kigali for the Commonwealth Heads of Government meeting. In a world where freedom and sovereignty are being threatened by aggressors, the Commonwealth is more important than ever. It represents a third of the world’s population and about 30% of the votes at the United Nations. The British Government will be backing Kamina Johnson Smith, the Jamaican Foreign Minister, as the new Secretary-General to ensure that the Commonwealth delivers for all its members in areas such as trade, investment and defending democracy.

Anne McLaughlin: In answer to an earlier question about Sri Lanka, the Under-Secretary, the hon. Member for Chelmsford (Vicky Ford), said that she would continue to lobby the Sri Lankan Government, but that Government, and their military, are populated in part by people who are credibly accused of war crimes in a civil war that ended more than 10 years ago. The Americans thought that there was enough evidence to impose economic sanctions on some of those individuals. Is lobbying really the best that she can do?

Vicky Ford: On Sri Lanka, let me start by absolutely emphasising again that violence against peaceful protesters is unacceptable. We absolutely condemn the violence we see happening at the moment and we are urging everybody towards calm. We will continue to work to make sure that we support the country through funding from our conflict, stability and security fund, which has supported peacebuilding, and we continue to respect the independence of the prosecutor when it comes to investigating war crimes of the past.

Lee Anderson: The world-class and well-respected Rwanda plan was designed to save lives in the channel, but the European Court of Human Rights is making a mockery of our attempts to protect our borders. Does my hon. Friend agree that it is now time to distance ourselves from the ECHR?

Vicky Ford: We were disappointed that last week’s flight was unable to depart, but we are not deterred from doing the right thing in delivering on our plans to control our nation’s borders. We are providing further information to the Court. It would not be appropriate to comment on individual cases at this time. However, we strongly believe that this project meets our obligations under both national and international law, and the Home Secretary has made it very clear that we will do what it takes to deliver this new partnership.

Lindsay Hoyle: I call shadow Secretary of State David Lammy.

David Lammy: As the Secretary of State knows, 10 days ago I visited Afghanistan. Millions face starvation. One widow whose husband was murdered during the Taliban takeover explained that she was so desperate for money that she had considered selling her kidneys so that she could eat. Meanwhile, conflict continues to rage across the world in Yemen, Lebanon, Ethiopia, Mali and of course Ukraine. Given the scale of the conflicts across the world and the hunger crisis being driven across the world, why is humanitarian aid down by 35% on pre-cut levels? Why are we the only member of the G7 cutting foreign aid, and what impact will this have on our national interests and reputation abroad?

Elizabeth Truss: We are a major donor of humanitarian aid. On the Ukraine crisis, we are the third largest donor in the world. Through our international development strategy, we are committing £3 billion-worth of humanitarian aid over the next three years.

Jason McCartney: Chevening scholarships enable exceptional students from around the world to come and study here in the United Kingdom. What is being done to make sure that Ukrainian students can take advantage of this excellent programme despite the horrific war in their homeland?

Vicky Ford: Prior to Russia’s terrible invasion, 68 Ukrainian candidates were shortlisted for interviews for those really special Chevening scholarships. Obviously, those interviews could not take place, but I am absolutely delighted to give those brilliant, talented and often young people some good news: they will all be offered scholarships. That will treble the number of Chevening scholarships offered to Ukraine. For those who are unable to take up their scholarships, if, for example, they are defending their country, they will be able to defer.

Layla Moran: Alaa Abdel Fattah is a British national currently imprisoned in Egypt. He is on day 81 of his hunger strike. He is an Amnesty International prisoner of conscience who has been imprisoned for his pro-democracy views for eight of the nine years since Sisi took power.  His family will be outside the FCDO today between 5 and 7 o’clock to ask, “Where is the Foreign Secretary?” Will she consider meeting them to discuss how we can ensure his release?

Elizabeth Truss: I assure the hon. Lady that we are working hard to secure Alaa Abdel Fattah’s release. Lord Ahmad has met the family and I am seeking a meeting with the Egyptian Foreign Minister who is due to visit the United Kingdom shortly, where I will raise this case.

Mark Menzies: Last year, I visited Bosnia to understand first hand the situation in the country. What steps is my right hon. Friend taking to ensure peace and stability in the western Balkans?

Elizabeth Truss: My hon. Friend is absolutely right; that is a vital issue. We are seeing attempts by Russia to destabilise the western Balkans. I recently visited Sarajevo, as has the Minister for Europe and North America, to do what we can to support the country through greater investment, so that there are alternatives to malign investment, and to make clear our support for security in the nation.

Cat Smith: Last week marked the 15th anniversary of Israel’s blockade of Gaza, which has caused a humanitarian crisis in the region. Will the Minister condemn the ongoing blockade and outline what steps the UK is taking to try to bring it to an end?

Amanda Milling: As it happens, after this session I will be travelling to Israel and the Occupied Palestinian Territories, which will obviously be a good opportunity to explore a number of different issues and our bilateral relationship with Israel.

Gavin Williamson: Across the horn of Africa, we are seeing one of the worst droughts in 40 years. Coupled with the tragedy of the Russian invasion of Ukraine, that is pushing millions of people into starvation. What more can we do to help on the ground and save lives? [R]

Vicky Ford: This is a terrible tragedy. So far this year, we have provided more than £72 million of additional support to countries in the region, which is helping about 8 million people. We played a vital role in convening a roundtable in Geneva that raised about $400 million. Last week, I wrote to the president of the World Bank to urge it to mobilise further funding urgently. I will meet representatives of the Disasters Emergency Committee later this week to discuss further steps.

Alex Norris: My constituent Godwin Suh from Bafut in Cameroon, who now lives in Nottingham, came to see me. He described the political violence that, as anglophones, he and his family have suffered. His brother is missing, his nieces and nephews have been hospitalised, and lately his house there has been badly damaged by Government forces. Will the Minister for Africa meet me and Godwin to hear more about the human rights challenges that many face in north-west and south-west Cameroon?

Vicky Ford: The hon. Gentleman is absolutely right; the human rights situation in north-west and south-west Cameroon is really concerning. There have been recent incidents with tragic civilian casualties. I would be happy to meet and discuss it with him.

Felicity Buchan: I welcome the statement last week that we are talking to our international partners about a Marshall fund for Ukraine. I previously suggested that we should consider not only seizing the assets of sanctioned Russians, but monetising them, either by putting a lien on them or by outright sale. Clearly, that would need to be done in conjunction with partners. Has my right hon. Friend considered that?

Elizabeth Truss: We are working with our allies and Ukraine on a new Marshall plan to help reconstruct Ukraine after the appalling war. There will be a Ukraine recovery conference in Lugano in the coming weeks, at which the United Kingdom will put forward our offer. We are looking at how we can seize Russian assets to help fund the rebuilding of Ukraine, which is something we are working on across Government and with our G7 partners.

Meg Hillier: A recent report by the Hong Kong Watch non-governmental organisation found that five Hong Kong officials and six lawmakers complicit in the ongoing human rights crackdown currently own property in the UK, so will the Government now commit to using the Economic Crime (Transparency and Enforcement) Act 2022 to sanction these Hong Kong and Chinese officials?

Amanda Milling: We remain deeply concerned about the appalling human rights violations in China and about the deterioration of rights and freedoms in Hong Kong. We keep all evidence on potential designations under close review, guided by the objectives of the relevant sanctions regime, but it is not appropriate to speculate about future sanctions and designations as to do so would reduce their impact.

Caroline Dinenage: It is vital that we do not forget the painful lessons we learned in the wake of Hurricane Irma in 2017, a key component of which is always to have a naval presence in the region ahead of hurricane season. Will the Minister please assure me those preparations are already being made?

Amanda Milling: The Department co-ordinated a cross-Government hurricane exercise earlier this month as part of its review of plans to ensure the UK provides a rapid and effective response this year. Officials also hosted a pre-hurricane season conference in May. Having visited Anguilla, the British Virgin Islands and the Cayman Islands, I totally understand the importance of hurricane preparedness. I reassure my hon. Friend that I met the Minister for the Armed Forces last week to discuss how our Departments can work together on an effective and appropriate response in the event of a major disaster.

Lindsay Hoyle: I call the Chair of the Select Committee, Sarah Champion.

Sarah Champion: Is the Foreign Secretary aware that the FCDO has set an annual budget limit for the Independent Commission for Aid Impact that will prevent it from carrying out the workplan to scrutinise UK aid that it previously agreed with my Select Committee? Will she look into this, please?

Elizabeth Truss: I am very happy to look into it and to discuss it with the hon. Lady.

Craig Tracey: I recently took over as chair of the all-party parliamentary group for Latvia, and it was a pleasure to meet my opposite number from the Latvian Parliament, Rihards Kols, last week to discuss the importance of our future work together. Does the Minister agree that, now more than ever, it is important that we strengthen even further our long-standing relationship with countries such as Latvia that share a common set of values and principles with the UK?

James Cleverly: I congratulate my hon. Friend on taking up his position. The UK enjoys close diplomatic, security and economic relations with Estonia, Latvia and Lithuania. I recently went to Estonia, and my right hon. Friend the Foreign Secretary has also been to the region and taken part in the three seas initiative that co-ordinates a number of workstreams in the Baltic and other parts of eastern Europe.

Imran Hussain: Since the illegal revocation of articles 370 and 35a, it has become absolutely clear that the right-wing Modi Government are bolder than ever before in their persecution of Kashmiris and minority groups in India. Most worrying, however, is the acceleration in their use of arbitrary arrest and detention of political and human rights activists, including Yasin Malik and hundreds of others, under the illegal Public Safety Act, which takes away any right to due process, yet the UK Government remain silent once more. Does the Foreign Secretary think it is right to continue negotiating a trade deal with the right-wing Modi Government, even at the expense of the blood of innocent men, women and children?

Elizabeth Truss: We are very clear that it is for the Indian and Pakistani Governments to find a long-term solution to Kashmir.

Andrew Percy: Canada is a key partner, and this morning I met the Speaker of the Legislative Assembly of Alberta, Nathan Cooper, who is keen to emphasise the potential for Alberta to help the UK through its present energy crisis. What is the Foreign Secretary doing to further deepen our relationship with Canada?

Elizabeth Truss: Canada is one of our closest allies. It is a fellow member of the G7, NATO and the Commonwealth, and we will shortly be joining it in the comprehensive and progressive agreement for trans-Pacific partnership. I speak regularly to my Canadian counterpart, and we are looking together at how we can bolster our energy security, in areas such as the one that my hon. Friend mentioned but also in the area of nuclear co-operation.

Kim Johnson: On Sunday, Francia Márquez, an internationally recognised environmental and human rights campaigner, made history by becoming the first black woman to be elected Vice-President of Colombia. Colombia is the most dangerous place in the world to be an environmental activist. Will the Minister commit herself to working with Francia Márquez and her new colleagues to ensure that the social and environmental rights of Colombia’s indigenous population are protected, and that UK aid for environmental programmes prioritises the protection of activists?

Vicky Ford: We work in Colombia on projects to promote peace and stability and also on projects to promote the environment and tackle climate change, and we will continue to do so.

Robert Jenrick: The solution to the inflationary crisis that we face, driven by high energy prices and a lack of supply, is primarily international. What is my right hon. Friend the Foreign Secretary doing to challenge OPEC’s position of not intending to take action to increase supply? That strikes me as the single most important thing that the British Government could do to tackle the crisis internationally.

Elizabeth Truss: As my right hon. Friend says, we need to tackle energy supply. In the long term, that means more renewables and more use of nuclear energy, but in the short term, it does involve looking at oil and gas. My colleague the Energy Secretary is working closely with his counterparts, particularly in the Gulf region, and I also have frequent conversations with them. We do need to see supply increase in order to lower global process.

Valerie Vaz: Will the Minister please update the House on the cases of the British citizens Morad Tahbaz and Mehran Raoof, who are still in Evin prison in Iran?

James Cleverly: I can assure the House that the UK Government remain completely committed to securing the full release of British dual nationals held in Iran. That passion has not been diminished. I assure the right hon. Lady and the House that we will continue to work on this with as much alacrity and passion as ever we have.

Gregory Campbell: On the issue of the Northern Ireland protocol, can the Foreign Secretary give an assurance to businesses in Northern Ireland that are adversely affected by the east-west trade to which she has alluded that that problem will be solved as a result of her Bill, along with other political problems that will also be resolved as long as she proceeds with the Bill?

Elizabeth Truss: I can assure the hon. Gentleman that we are proceeding with the Bill. We are also proceeding with close consultations with business on the precise design of the red and green lanes to ensure that it works for companies in Northern Ireland and Great Britain, and also in the Republic of Ireland and the European Union, so that we can deliver the Bill as intended, freeing up east-west trade but also protecting that very important north-south relationship.

Rachel Hopkins: Bangladesh and northern India are facing some of the worst floods for 100 years. Many of my constituents are extremely worried about family and friends, especially in the Sylhet area. Can the Minister assure us that the Government will take action in respect of humanitarian aid, particularly when it comes to food, water and sanitation?

Vicky Ford: I will certainly raise that with the Minister responsible, Lord Ahmad.

Joanna Cherry: When I led the Joint Committee on Human Rights delegation to Strasbourg last week, we were repeatedly told that threats made by the United Kingdom to withdraw, or even just disengage, from the European convention on human rights risked giving succour to eastern European states, including Russia, which do not have the same respect for human rights and the rule of law that the United Kingdom has historically had. Will the Foreign Secretary tell the Prime Minister to tone down his veiled threats to leave the convention, and tell her more excitable Back Benchers to back off?

Elizabeth Truss: I honestly thought that the hon. and learned Lady would welcome the fact that the UK led in kicking Russia out of the Council of Europe and holding it to account.

Bills Presented

War Pension Scheme and Armed Forces Compensation Scheme (Public Inquiry) Bill

Presentation and First Reading (Standing Order No. 57)
Owen Thompson presented a Bill to establish an independent public inquiry into the administration of the War Pension Scheme and of the Armed Forces Compensation Scheme by Veterans UK; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 September, and to be printed (Bill 51).

Ministerial Code (Enforcement) Bill

Presentation and First Reading (Standing Order No. 57)
Owen Thompson presented a Bill to make provision about the enforcement of the Ministerial Code; and for connected purposes.
Bill read the First time; to be read a Second time on Friday 16 September, and to be printed (Bill 112).

Ministerial Interests (Public Appointments) Bill

Presentation and First Reading (Standing Order No. 57)
Owen Thompson presented a Bill to require a Minister to make an oral statement to Parliament if a person is appointed to a paid post by them, in whom, or a company in which, that Minister has a personal, political or financial interest.
Bill read the First time; to be read a Second time on Friday 16 September, and to be printed (Bill 113).

Opposition Day - [3rd Allotted Day]Opposition Day

Access to GP Services and  NHS Dentistry

Lindsay Hoyle: I call the shadow Secretary of State for Health.

Wes Streeting: I beg to move,
That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.
Mr Speaker, thank you for the opportunity to open this debate on the future of primary care, access to GPs and access to dentists. It is a particular delight to see the Secretary of State here. I so enjoyed our exchange of letters last week that I cannot wait to repeat the exchange in real life.
Primary care is the front door to our NHS—for most of us, the general practitioner is the first port of call when we are worried about our health—but after 12 years of Conservative mismanagement and underfunding of our health service, the front door is jammed. Patients are finding it impossible to book GP appointments, serious conditions are going undiagnosed, patients are waiting longer than is safe for treatment, with backlogs building up and greater pressure placed on the rest of the health service, and millions of people are waiting more than a month to be seen, often in pain and discomfort.

Catherine West: My hon. Friend has made an excellent beginning to his speech. What is his view of my local hospital, where, instead of 350 people daily, we have 710 people coming into accident and emergency at the North Middlesex Hospital? What response does he have to that kind of demand? Where is it going to lead if people cannot see a GP? They are going to end up in A&E.

Wes Streeting: My hon. Friend is absolutely right to highlight that problem. If the front door of the NHS in primary care is jammed, people end up presenting in A&E. As I shall outline in my speech, this is not only a great inconvenience and burden to patients; it comes at an additional cost to the NHS and we all pay the price for that in every respect.

Alex Cunningham: At the GP practice in Norton in my constituency, it is almost impossible to get an appointment on the phone. I have dozens of cases of individuals unable to access vital care. One tried 196 times. The Care Quality Commission has not inspected this practice since 2015. Does my hon. Friend agree that it ought to be doing so now?

Wes Streeting: Even in the context of the pressures that we see right across primary care—I think every GP practice would acknowledge they face challenges—the case my hon. Friend has just described sounds extreme. We cannot allow the decade or more of mismanagement we have seen from this Government to excuse that kind of care, or indeed absence of care, for patients, and that brings me on to the next point I want to make.
We know why patients are forced to wait: Conservative Governments have cut 4,500 GPs over the last decade, they have closed 300 practices since the last election and they have failed to provide any meaningful reform of the system. The public are sick and tired of waiting. Public satisfaction with GP services stands at the lowest level on record as patients become ever more frustrated with not getting an appointment when they need one, or in a manner to suit them.
It says so much about the NHS at the moment that, while we have the lowest level of patient satisfaction since 1997, when we ask the public whom they trust, nurses and doctors are right up at the top of the list. The public understand that the staff who work in the NHS are trying to grapple with the biggest crisis in its history. Of course, the Government will want to pin that simply on the pandemic, but that does not explain why we went into the pandemic with NHS waiting lists already at record levels, with 100,000 staff vacancies in the NHS and with a decade or more of under-investment, leaving us ill-prepared for the pandemic—or, in the words of the Culture Secretary, “found wanting and inadequate”—but also now struggling to get the recovery from the pandemic that we need to build the health and care service we need for the future.

John Redwood: The shadow Secretary of State says that we need GP reform. What kind of reform does he have in mind? What does he think should be the right balance between in-person, online and telephone consultations?

Wes Streeting: I am grateful to the right hon. Gentleman for that intervention. I will conclude my speech by talking about what a Labour Government will do, but let me answer his direct point about the range of options through which people should be able to access their GP. I value patient choice. Thinking back to my experience of accessing NHS services last year—as many people know, I did quite a lot of mystery shopping on the NHS—I had a range of interactions with GPs. Some were face-to-face. Some interactions at my GP surgery were not with my GP but with a nurse, which was entirely appropriate and much appreciated. Some of my engagements with my GP were over the telephone. I also had a video consultation with a dermatologist. I really valued that flexibility and range of approaches.
I think that the future for primary care has to be different courses for different horses. Of course, people should have a right to see their GP when they want to see their GP—I am clear about that—but there is also a range of ways in which we can offer more flexible access to GPs, particularly for working people who do not necessarily want to traipse down to the GP surgery in the middle of the afternoon if it is something that could be dealt with over the phone or on a video call.

Layla Moran: The shadow Secretary of State is making a powerful speech. I commend in particular the point he made that  people still trust their doctors. They are desperate to see them, even if it is online. A 74-year-old constituent of mine contacted me and said that he asked for an online appointment but it would take him 30 days to get there. He appreciates that the issue is not with GPs but with the Government’s lack of planning for the number of GPs who can provide that service in Oxfordshire.

Wes Streeting: The hon. Lady makes a powerful point. How is it that the NHS can be one of the largest employers in the world—it employs 1.2 million people—but does not have a workforce plan and strategy that says, “This is the workforce need that we have today, this is what the workforce need will be in the foreseeable future and, in the longer term, this is how we need to change the shape of the workforce to take into account advances in medicine and modern technology, and the changing demographics of our society”?
We gave the Government the opportunity to commission such a report when we debated the Health and Care Bill. It was supported on a cross-party basis, including by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—sadly, he is not able to be with us at the moment—yet the Government voted against it. What is it about the ostrich mentality of the Secretary of State and his ministerial team—or, I suspect even more, that of the Treasury—that they would rather bury their heads in the sand, pretend there is no problem with workforce and not even count the numbers of doctors and nurses needed because they worry that the Treasury might face up to the reality of what they need to provide?

Alison McGovern: Is it not the case that, in the pandemic, the Government fundamentally misunderstood the connection between the health of the nation and its economic success? All the argument the shadow Secretary of State makes about the NHS workforce and what they can achieve for our country shows that the Government are still making the very same mistake.

Wes Streeting: I wholeheartedly agree with my hon. Friend, who understands well the link between the health of the nation and the health of the economy. Given the labour market challenges in this country, it is simply not acceptable that we are losing so many people who could be in the labour market to ill health. We are also losing so many people from the labour market who are caring for relatives, because there is a disproportionate burden on families. Who disproportionately bears the burden of that care? It tends to be women, so we are losing a whole tranche of women from the labour market who could be contributing to the growth of the nation and the economy.

Several hon. Members: rose—

Wes Streeting: I will give way one more time and then I need to make some progress.

Jim Shannon: It is not just about GPs and surgeries; it is about dental access as well. In my constituency and across the whole of the United Kingdom of Great Britain and Northern Ireland, dentists are prepared to take private care and monthly care, but they will not take NHS patients. As poverty levels and  prices rise, dentistry is at the end of the queue. Does the hon. Gentleman agree that dentistry is at crisis point and that Government intervention is absolutely critical?

Wes Streeting: The hon. Gentleman is right to describe the state of dentistry and I will be getting my teeth into that issue very shortly.
[Hon. Members: “Groan!”] It had to happen at some point. I had to get it in at some point. Let me touch on the other issue he mentions, which is about inequality and inequality of access.
The system in primary care is entirely unequal. Some areas have twice as many doctors as other parts of the country, with as many as 2,800 patients fighting over one family doctor. Patient safety is being put at risk. Last week, the BBC revealed the scale of the crisis in GP surgeries with its investigation into Operose Health. Patients who can get an appointment are seen by less qualified staff, standing in for GPs without supervision. Patient referrals and test results were left unread for up to six months: private profit placed above patient safety. When the Health Secretary was asked about that last week, he said:
“we expect local commissioners to take action.”—[Official Report, 14 June 2022; Vol. 716, c. 140.]
Well, it is not good enough to sit back and wait for others to act. Is an investigation happening? Can he tell us? If not, why on earth has he not launched one? [Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), from a sedentary position, talks about the last Labour Government. When are the Conservatives going to wake up to the fact that they have been in government for 12 years? Twelve years! It is remarkable. Twelve years they have been in government.

Felicity Buchan: rose—

Wes Streeting: Perhaps the hon. Lady could tell us why they want to run away from their record of 12 years.

Felicity Buchan: I thank the hon. Gentleman for giving way. He makes grand statements in support of the NHS, but I am afraid his actions do not support the NHS. He has backed these train and tube strikes today, which have meant that in my constituency patients cannot get to hospital, and nurses and doctors cannot get to their places of work. Can we have better action, rather than words?

Wes Streeting: I am very, very grateful to the hon. Lady for that intervention. Our party has been clear: we did not want to see the strikes go ahead. We believe the strikes could have been averted if the Government had shown responsible action. The absolute brass neck of the Secretary of State! It is one thing pretending they have not been in government for the last 12 years; now they are pretending they are not in government today and that, somehow, it is down to me, the shadow Health Secretary. Somehow, if I had uttered the magic words, “Don’t go ahead,” the RMT would have said, “Oh no, the shadow Secretary of State for Health has spoken now. We better put a stop to it.” [Interruption.]

Lindsay Hoyle: Order. I want to help a little bit. We do not want to open up a debate that is not down for today. We have got a little bit carried away. The hon. Member  for Kensington (Felicity Buchan) got in, and I was quite right to allow a response, but I think we have heard enough now.

Wes Streeting: Thank you, Mr Speaker.
I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are
“all as ants before the might of the all powerful shadow health secretary”.
When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?

Clive Efford: The “Panorama” programme also exposed the fact that GP practices are being hoovered up by the private sector. Operose Health now owns 70 practices, with more than 600,000 patients. That exposes the fact that there is now a value to GP patients lists and that they are being sold on. They are collected by GPs, free of charge and then, as they are amassed in great number, they are sold to the private sector. Is my hon. Friend, like me, concerned about that practice?

Wes Streeting: I wholeheartedly agree with the point my hon. Friend makes. It is simply not good enough for the Minister to keep on talking about what the last Labour Government did. If she does not agree with the situation described by my hon. Friend, which is happening on her watch, why does she not legislate? If she is incapable of governing, she should make way for people who can govern.

Catherine McKinnell: I commend my hon. Friend for the tone of the speech that he is making, because it is vital that we stand up for our NHS, which the Government are failing to do. They seem happy to let everybody be angry with their GPs and about their inability to seek the medical help they need, but very unwilling to do something about it. Is this argument not really one to be had with the Government entirely? They should be making sure that we have sufficient GPs to treat the people in this country.

Wes Streeting: I wholeheartedly agree with my hon. Friend; it is the trend with this Government to seek division, sow division, pass the buck, devolve the blame and not take responsibility for anything. What Opposition Members would not give for just one day of being able to govern in the interests of the people in this country! This Government want to give the appearance of being in office but not governing at all. That is what is happening on their watch. If that is not bad enough, against a difficult economic backdrop, with scarce resources, not only is the way in which they manage and govern bad for patients, but it is squandering taxpayers’ money.

Dr Caroline Johnson: rose—

Wes Streeting: I will give way in just a moment. The problems in general practice are storing up problems for the rest of the NHS; as we have heard, people are  presenting in accident and emergency because they cannot see a GP. That failure is costing the taxpayer dearly. A GP appointment costs the NHS £39, but a visit to an urgent care centre costs it £77 and a visit to the emergency department costs it £359. The Government’s failure to invest in new GPs may be penny-wise but it is pound-foolish. It is wasting money and inconveniencing patients, and it is not the way to manage the NHS. One of my constituents wrote to me yesterday to say that if she wants a same-day appointment for her baby, her GP sends her to A&E. She wrote:
“I was sent to A&E to check a newborn baby’s suspected ingrown toenail that had no sign of infection. How is going to A&E for a non-urgent matter a good thing for anyone.”
Yet that is what our constituents are forced to do, because they cannot get a GP appointment. I hope the hon. Member for Sleaford and North Hykeham can give us some insight as to why.

Dr Caroline Johnson: As part of that, I suggest that the hon. Gentleman remembers that GPs take 10 years to train. He is right to say that we have been in government for 12 years, but most of the current GP shortage is because the previous Labour Government did not train those GPs at the time. One of the first things the Conservative Government did was to set in train the opening of five medical schools to increase the number of medical students. We had enough doctors but they do take 10 years to train. The reason I stood up to intervene on the hon. Gentleman was to say that one of the challenges that doctors—I refer to my entry in the Register of Members’ Financial Interests, as a doctor—and members of staff face is being abused in a surgery. I wonder whether he would like to apologise for some of the comments he has made on social media—

Lindsay Hoyle: Order. Interventions are meant to be questions. I know that the hon. Member is down to speak. I would not want you to use up your speech now; I want you to save something for later.

Wes Streeting: Let me first say in response to the final point the hon. Lady made that there is absolutely no excuse for abusing NHS staff whatsoever. Most people in this country do not blame NHS staff for the state of the NHS; they place the blame squarely where it belongs, with the Government who have been in power for the past 12 years. Her first point would be more powerful if we did not have 1,500 fewer full-time equivalent GPs now than we did when her party came to power. Her point would have been more powerful if her party had not whipped its MPs to vote against having a workforce plan for the NHS, but I am afraid that that is what it did. Conservative Members cannot run way from their choices and decisions, and from the fact that they have now been in government for 12 years and there is no one else to blame but themselves. In communities right across the country, we now see the consequences of their mismanagement.

Jonathan Edwards: I regret to inform the hon. Gentleman that the situation in Wales is not much better, but I do not want to make a party political point. Will he commend the potential role that pharmacists can play in alleviating  pressure on GPs? I have an excellent pharmacist in my home village of Pen-y-Groes, which provides an invaluable service for the communities in my area.

Wes Streeting: I wholeheartedly agree with the hon. Gentleman’s point about the importance of looking at primary care as a whole and the really powerful and valuable contribution that community pharmacies can make, alleviating pressures on other parts of the primary care system, particularly general practice.
Communities across the country are experiencing those problems; let me take one place at random to illustrate the scale of the challenge. Today, after a decade of Conservative mismanagement, the city of Wakefield has 16 fewer GPs than in 2013. In fact, Wakefield has not seen a single additional GP since the Prime Minister promised 6,000 more at the last election, and since Wakefield has been served by a Conservative MP—albeit, thankfully, no longer—it has seen three GP practices close, with some surgeries so short-staffed that 2,600 patients are left to fight over one family doctor. Last month, patients in Wakefield were able to book 25,000 fewer GP appointments than in November 2019, the last month in which they were served by a Labour MP. The only good news for general practice in Wakefield in recent years has been that Simon Lightwood, an NHS worker and brilliant candidate in Thursday’s by-election, has successfully campaigned to save the King Street walk-in centre. [Interruption.] They don’t like it. Conservative Members shout in protest and point the finger at us, but they have been in government for 12 years.

Richard Fuller: The hon. Gentleman is talking about problems, but his motion does not include one solution. He has now been speaking for 20 minutes, and he has not outlined one solution. If he wishes to be taken seriously as a politician, will he now turn to some solutions to the problems he has outlined?

Wes Streeting: It is certainly true that I am saving the best until last in my speech, but the hon. Gentleman may have missed the point I have made repeatedly, which is that the NHS—an organisation that employs more than 1.2 million people—needs a workforce strategy. It needs a proper analysis of what its workforce needs are today, the workforce needs of tomorrow, and the future shape of the workforce. We gave Government Members the opportunity to vote for that; the hon. Gentleman voted against it, and he wants to lecture me about being taken seriously as a politician. Who is he trying to kid? I do not know how the hon. Gentleman voted, because it was a secret ballot, but the fact that a majority of Government Members voted to keep the current Prime Minister in office means that they are not in any position at all to lecture anyone else on who is and is not a serious politician.

Andrew Selous: I am very grateful to the shadow Secretary of State for giving way. I have in front of me figures from the House of Commons Library on the increase in GPs per 100,000 population between September 2015 and April 2022, which show an 8% increase for Wakefield.

Wes Streeting: I notice that the hon. Gentleman has played the old trick of selecting figures from a specific set of years, but nothing he has said contradicts the facts that I have outlined. In any case, the people of Wakefield will draw their own conclusions on Thursday when they go to vote. The fact is that the Government have had more than enough time to reform general practice in this country, and they have no one other than themselves to blame for the crisis we are in.
Since the Conservative party has been in government for the past 12 years, I thought I would take a trip down memory lane to remind us, the House and the British people exactly what they have been promising since they were first elected in 2010. The 2010 Conservative party manifesto promised that GP surgeries would be open 12 hours a day, seven days a week. The Government failed to deliver that—maybe they blame their coalition partners, although I do not think the Liberal Democrats would have disagreed with GP surgeries being open for that long—so they promised the same again in 2015. That time, they set themselves a deadline of 2020, and guess what? They missed that, too.
In 2015, they promised that everyone over the age of 75 would get a same-day appointment—another promise broken. They said they would hire 5,000 more GPs by 2020—another promise broken. In 2019, they promised 6,000 more GPs, but the Health Secretary has already admitted that he is on course to break that promise, too. They promised 50 million more GP appointments a year, but as the British people know from their experience, appointments are down. That is today’s Conservative party: over-promise and under-deliver, never take responsibility, and leave patients paying the price.

Lilian Greenwood: This morning, one of my constituents contacted me to say she was standing outside her GP practice at 7.15 am in order to secure an appointment. She said that she was successful in securing an appointment, but a number of people who were also standing outside did not. Does my hon. Friend remember the Health Secretary promising that people would have to do that in order to secure a GP appointment?

Wes Streeting: I wholeheartedly agree with my hon. Friend. This is the problem: they overpromise and underdeliver. If they will not hear it from me, Mr Speaker, let us remind ourselves of what some of the Secretary of State’s colleagues have said. The hon. Member for South West Bedfordshire (Andrew Selous), who is in the Chamber, said in Prime Minister’s questions only last week:
“At one of my surgeries, which has double the recommended number of patients per GP, the bowel cancer diagnosis of a 51-year-old father of four was missed and is now terminal.”—[Official Report, 15 June 2022; Vol. 716, c. 283-4.]
Earlier this month, the hon. Member for Telford (Lucy Allan) read a letter from a constituent to the Health Secretary. It said:
“Trying to get basic healthcare is a joke in Telford. Maybe I would be better off in…a third-world country”.
If the Secretary of State is not going to listen to us, he should at least listen to his own side. Before Conservative Members leap to the defence of their Government’s record, they should probably go back and check the record to make sure that they had not agreed with us in the first place.
As for dentistry, 2,000 dentists quit the NHS last year, around 10% of all dentists employed in England. It is an exodus under the Government’s watch. Four million people cannot access NHS dental care and cannot afford to go private either.

Alex Sobel: My hon. Friend is making an excellent speech. My constituent, Ellie Cokeley, wrote to me. She works as a receptionist in a local dental practice and gets hundreds of calls a week from upset members of the public who are unable to find an NHS dentist. She said that it feels greatly unjust that the poorest in our society are being forced to pay huge amounts for vital dental care or, worse still, having to continue without any at all. Are the Government not failing people in this country when it comes to the care of their teeth? It is vital that we get more dentists in the system.

Wes Streeting: My hon. Friend is absolutely right. Some places, such as Somerset, are dentistry deserts because the remaining NHS dentists are not taking on new patients.

Several hon. Members: rose—

Wes Streeting: I will give way first to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), then to my hon. Friend the Member for Hackney South and Shoreditch (Dame Meg Hillier) and then to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone).

Sharon Hodgson: My hon. Friend mentioned Somerset, but can I also mention Sunderland, to keep up the alliteration? In Sunderland, we cannot find an NHS dentist and the few good ones we have are now turning to private practice to make it work. It is an existential crisis in dentistry—it really is at breaking point. Does my hon. Friend agree that the blame lies squarely with the Conservative Government, with backlog Britain, and that this is the effect on our constituents?

Wes Streeting: My hon. Friend is absolutely right about the state of dentistry. It is not alliterative, but I suspect that my hon. Friend the Member for Hackney South and Shoreditch has similar points to make.

Meg Hillier: A constituent of mine told me that she had a terrible toothache, rang 111 and was assigned to an emergency dentist. The system worked, but does my hon. Friend agree that that that costs the taxpayer so much more money? My hon. Friend talks about overpromising and underdelivering, but with dentistry the Government have not even promised anything and they are underdelivering.

Wes Streeting: My hon. Friend knows exactly what she is talking about. Of course, there is no one better in this House to make the point about the waste of public money. That is the outrageous thing about all of this. People are paying more and getting less. Their taxes have been put up, justified in the name of the NHS, but the money is not being directed in the right way to deliver better care. In fact, the Government admit that even with the investment they are putting in, people will be waiting longer for care and that is a disgrace.

Jamie Stone: I thank the shadow Secretary of State for giving way. He is very civil. Can I also go down memory lane? We have had a Government of a rather different colour in Scotland since 2007, and today I have constituents coming to me and saying, “I cannot get on an NHS dentist’s list”. That echoes the point made by the hon. Member for Strangford (Jim Shannon). Does the shadow Secretary of State agree that in the event of the present Government sorting this situation out, they would do well to share what they did with the Scottish Government? And in the event of a change of Government after the next general election, will the shadow Secretary of State commit to giving advice to the Scottish Government?

Wes Streeting: This is the thing that the First Minister of Scotland does not want to acknowledge, but for all her noise, bluff and bluster she knows full well that a Labour Government here in Westminster would be good for the people of Scotland. The investment and reform that we would put into the NHS to deliver the same kind of results as the previous Labour Government did would be good for the people of Scotland. I look forward to the day when I can phone the Scottish Government to give them some advice and I look forward to the day when the Governments in Westminster and Edinburgh are Labour Governments delivering for people across the United Kingdom.
The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) mentioned the trip down memory lane. The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes, regularly blames Labour for what is happening in dentistry. That is because of something that happened 16 years ago: it was a contract that was put in place by the last Labour Government, which we committed to reform in our 2010 manifesto. Unfortunately, that manifesto was never implemented. The tragedy is that the Conservative manifesto that promised reform of the dentistry contract was not implemented either.
In 2010, the Conservatives promised to introduce a new dentistry contract. In 2017, they also promised to introduce a new dentistry contract. What is the Minister’s policy today? She promises to introduce a new dentistry contract. She must make up her mind: either, the current contract is so good that every time she tries to change it, she cannot find a way of improving it, or, the Minister’s Department, her Secretary of State and her Government are so incompetent, so distracted, or so indifferent, that they simply cannot get the job done. It is no good their blaming the Labour party for the problems in NHS dentistry. They have been asleep at the wheel for 12 years. They have failed to do anything to improve the service, and now 4 million people cannot access a dentist. The consequences are severe.
Let me tell the Health Secretary about a constituent of my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper). She tells me that this constituent cannot get a dentist appointment anywhere for an unbearable toothache, and that they are in too much pain to sleep through the night. When they contacted a dentist, they were told that they would have to wait two years for an appointment. They wrote in an email:
“I am in such agony that I took Ibuprofen, drank whisky and tried to pull it out myself with plyers, but they kept slipping off and it was agony.”
What kind of country have we become when the most common reason for children to go to hospital is to have their teeth extracted? We have 78 children going to hospital every day to have their teeth extracted. [Interruption.] There is no point Members arguing from a sedentary position that it is because of fizzy drinks. That is their approach all the time. The system is broken, so let us blame the patients. It is absolutely outrageous. DIY dentistry in one of the richest countries on the planet, and their answer is to blame the patients. They should get real. This is so far from that original promise of the NHS, where care is provided to all who need it, when they need it.
To be fair to the Health Secretary, he has been in the role for just under a year, and, on that note, I would like to wish him a happy anniversary this Sunday for one year in the job. But I am afraid that that is where the niceties end, because I will now run through what he has said and done in his year in charge. He had a big media splash on “league tables for practices” to pressure them into doing more face-to-face appointments and then he backed down. He achieved great headlines on “nationalising GPs” in January—imagine the excitement—but there has been no action since. He talks about bringing the NHS into the Netflix age. Has he ever actually used the NHS app? I cannot even book a GP appointment through the app because my GP is not on it. Why is it still not available to every patient as a way to book appointments? I visited Israel recently—I refer to my entry in the Register of Members’ Financial Interests—where it has embraced the technological advances in medicine over recent years to massively improve access to healthcare for patients.
I was talking to a start-up, which is developing an app that tracks the recovery of stroke victims, and notifies them when they need to see a physio. I then showed the staff what the NHS app can do and what it cannot do and they laughed. In some senses, the Health Secretary had a point: the NHS is not as modernised as it needs to be to deliver for patients, and nowhere is that more true than in primary care. It is an analogue service in a digital age. Patients should not have to wake up at 8 in the morning and wait on the phone for an hour for an appointment. They should not be told to expect a call back, but given no indication as to what time that will be, and then be considered a missed appointment if they do not pick up because they are at work, or are busy, or are picking up the kids and doing everything else that people do between nine and five.
People have never been so well-informed about their own health. We carry around with us devices that can measure our exercise, our heart rate, how well we sleep, and so much more. Yet our healthcare system puts none of this to use and keeps all the pressure on GPs.
Let me conclude by outlining some of what a Labour Government would do to address this crisis—[Interruption.] I am not surprised that Conservative Members are excited; they must be as fed up as we are. First, we would take immediate practical steps to boost the number of GPs available. Why have the Government sat idly by while doctors are forced to retire early, for no other reason than that the cap on their pension contributions means they pay a financial penalty for staying on? Let us change the rules to keep the good doctors we have. Why is it that, at the last count, 800 medicine graduates had not been able to find junior doctor posts? Let us get them to work immediately—

Sajid Javid: That is rubbish!

Wes Streeting: It is rubbish, but it is his record.
Why is it that so many people are accessing NHS services because of a failure to invest in social care, where staff can be recruited and deployed a lot faster? On the dentistry contract, the last Labour Government acknowledged that the 2006 contract was not good enough, which is why we put the reform of that contract in our 2010 manifesto. The difference is that we will not wait 12 years to deliver the promise after the election of the next Labour Government. Those are just some of the practical steps that we would take immediately and that the Government could take immediately.
Let me tell the House about some of the fundamental issues we would fix. First, mental health services in this country are in such a state that GPs are seeing more and more of their own cases present with mental ill-health. A Labour Government would recognise that there has been a surge in mental ill-health following the pandemic and we would not leave it to overwhelmed GPs to see them. That is why we have committed to recruiting 8,500 new mental health professionals, including specialist support in every school and mental health hubs in every community. We would pay for that by ending the charitable status of private schools and closing the tax loopholes enjoyed by private equity fund managers—and do not tell me the Health Secretary does not know where they are; he was using them before he became a Member of Parliament.
That policy—[Interruption.] Conservative Members are funny. They ask for our policies but they do not like it when we provide the answers, because we have them and they do not. That policy, which would put mental health hubs in every community and support in every school and speed up access to treatment for everyone in our country, would help to reduce pressure on GPs and to deliver better mental health treatment in every community and faster access to a GP for everyone else who needs to see them. It also tells you something about the choices we would make and the priorities we would have as a Labour Government: better public services enjoyed by the many, paid for by closing tax perks for the few.
I know that there is lots of cynicism about politics. We have a Prime Minister who wants people to believe that we are all the same, that things cannot change and that his shambles of a Government are the best that Britain can do. All I would say to the people of Britain is this: judge them on their record and judge Labour on ours. They have been in power now for 12 years. They delivered the highest NHS waiting lists in history, before the pandemic. They delivered record staffing shortages in the NHS with 100,000 vacancies, before the pandemic. They delivered cancer care that worsened in every year since they came to office, before the pandemic. Now they tell us that patients will be paying more and waiting longer.
The last Labour Government were in power for 13 years, and we delivered the highest patient satisfaction in the history of the NHS, the lowest waiting times on record and more doctors, nurses and new hospitals. There were no threats of strikes in the NHS when we were in government because staff could see the difference we were making and so could the patients. We did not get everything right—nobody is perfect—but Labour’s record  on the NHS is one that this Government could not even begin to touch. The longer we give the Conservatives in power, the longer patients will wait. Well, people are sick, and they are tired of waiting. This Government’s time is up.

Sajid Javid: I welcome this chance to come to the House to discuss primary care and dentistry, but I have to say that the audition by the hon. Member for Ilford North (Wes Streeting) did not go very well. I hope that he can see the irony—some might even say the hypocrisy—of his sudden interest in access to public services, today of all days. It is thanks to the strikes that he has been so vocal in supporting the fact that people right across the country cannot make their appointments, that GPs and dentists cannot get to work and that patients do not have access to the treatments they desperately need.

Several hon. Members: rose—

Sajid Javid: I will take some interventions in a moment.
The hon. Gentleman has had every opportunity to do the right thing, to put patients first and to condemn these unjustified and reckless transport strikes, yet at every turn he has chosen to back his union paymasters.

Catherine West: rose—

Sajid Javid: I hope the hon. Lady will condemn the strikes.

Catherine West: The Secretary of State speaks about opportunities. In this House, we had a number of opportunities to get workforce reform, workforce numbers and a plan for our health service into the Health and Care Act 2022. Why did he miss those opportunities?

Sajid Javid: We are seeing record investment in the workforce, and we are seeing record increases. For the first time ever, the NHS is also coming up with a 15-year long-term workforce strategy, which I hope the hon. Lady welcomes.
The Government have always been on the side of patients and the people who care for them. I pay tribute to everyone working in primary care and dentistry for the difference they make day in, day out to their patients’ lives. I know that the pandemic has brought some unimaginable pressures, and equally I know that many of those pressures have not gone away now we are living with covid.
The hon. Member for Ilford North talks as though he does not know where the pressures have come from—as though he has had his head under a rock for two years. The NHS has said it believes that between 11 million and 13 million people stayed away from the NHS, including their GPs and dentists. Rightly, many of those people are now coming forward for the treatment they need—and I want them to come forward.

John Redwood: When the Secretary of State does the much-needed manpower review, will he ensure that a fast-growing area such as Wokingham with lots of new houses gets proper provision for that growth? Will the manpower plan also address how we recruit the doctors we have authority to get?

Sajid Javid: I absolutely agree with my right hon. Friend’s important point. In fact, I met my hon. Friend the Member for South West Bedfordshire (Andrew Selous) about that last week, and I agree with them both.

Hilary Benn: Last month, a constituent contacted me who had developed severe dental pain. He phoned 40 dentists and not one of them could take him on as an NHS patient. It got so bad that he phoned 111 but was told that he was not eligible to see an emergency dentist. What advice would the Secretary of State give to someone in those circumstances? Many other hon. Members on both sides of the House will be able to tell similar stories. In the end, my constituent had to pay to go private, but that should not have happened. Why are our constituents being placed in that position?

Sajid Javid: I am sorry to hear about the right hon. Gentleman’s constituent. If he will allow me, in a moment, I will come on to the pressures that dentistry is facing and, most importantly, what we are doing about them.
Those pressures have come about for two reasons. First, there was a fear of infection, which was understandable in a context where 10 minutes in a dentist’s chair during the pandemic could have meant 10 days in self-isolation or, perhaps, worse. Dental practices were almost uniquely at risk of spreading covid, so their activity was rightly severely constrained across the world—not just here in England and across the UK—by the infection prevention rules that were necessary at the time. Despite all the innovations in dentistry over the last few years, dental surgeries do not have a Zoom option.
Secondly, the British people stayed away because of their innate sense of responsibility during the pandemic. As all hon. Members saw in their constituencies, people understood our critical national mission. Our GPs were doing their duty vaccinating people in care homes and in thousands of vaccination centres up and down the country, protecting the most vulnerable and working hard to keep us all healthy and safe.
When omicron struck—we all remember that period, which was not that long ago—I stood before this House and asked GPs to stop all non-emergency work once again. I did not take that decision lightly, but we were faced with a stark choice of having more lockdowns or accelerating our vaccine programme. We chose to accelerate, with help from all corners of the NHS and with the backing, at that time, of the hon. Member for Ilford North. I remember him standing at the Dispatch Box pledging his full support for that effort and rightly stating that the Government were acting
“in the best interests of our NHS, our public health, and our nation.”—[Official Report, 13 December 2021; Vol. 705, c. 795.]
He recognised that it was the right thing to do then; he has now conveniently changed his mind. I wonder why.

Mike Amesbury: But people like Mark in my constituency cannot find an NHS dentist. This is not about covid; it was happening before covid. The investment just is not there. He is in pain; he is in agony. The Secretary of State needs to step up, step in and get things right.

Sajid Javid: We are putting record amounts of investment into the NHS, including more funding into dentistry—I am about to come on to that right now—which will help with those pressures.

Clive Efford: Covid is just a pathetic excuse, because even if it was the sole reason, the Secretary of State should have been planning for when we came out of it, but nothing he has said explains why we had record numbers of patients on waiting lists even before covid started.

Sajid Javid: I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.

Emma Hardy: Excuse me for raising this issue, but I want to draw attention to the fact that there has been news released that the Secretary of State’s Government have declined to introduce mandatory reporting of complications resulting from mesh. In the context of problems with waiting lists, and wider issues, if we do not introduce a mandatory reporting scheme to identify problems with a medical product, more people will end up requiring medical intervention and medical treatment, so I urge the Government to look again at their declining to introduce mandatory reporting.

Sajid Javid: The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.

Paul Bristow: Does my right hon. Friend agree that a lot of the issues with primary care services are about leadership? In my constituency, we have the brilliant Thistlemoor surgery with Dr Neil Modha and Dr Azhar Chaudhry, who serve 29,500 patients, 80% of whom do not have English as a first language. Same-day, face-to-face GP appointments are the norm in that practice. In contrast, a Thorney surgery has just temporarily closed a surgery in my constituency due to a lack of admin staff, which is not the fault of the admin staff themselves. Will he back my campaign to make sure that that GP surgery is open again serving local people as soon as possible?

Sajid Javid: My hon. Friend is campaigning passionately for primary care services in his constituency, and he points to some fantastic practices. I congratulate all the people involved in delivering that and support him in his work with his local commissioners to make sure that they are getting even better local primary care.

Andrew Murrison: Does my right hon. Friend recognise that the crisis in NHS dentistry, which affects my constituency as it does his, well predates the pandemic, and indeed goes back to at least 2006 when the then Labour Government changed the way in which dentists are paid? Will he undertake to look at the units of dental activity  system, which disincentivises dentists from providing dental work particularly in the most disadvantaged communities?

Sajid Javid: My right hon. Friend is absolutely right in his analysis, and I can give that undertaking. I will say a bit more about that in a moment.
If the hon. Member for Ilford North wants to talk about funding for the NHS, I am happy to oblige. Under the last NHS long-term plan, before the pandemic, we made a historic commitment of an extra £34 billion a year. Because of the pandemic, we then necessarily put in £92 billion of extra funding. At the last spending review, we increased funding still further so that the NHS budget will reach £162.6 billion by 2024-25, supported in part by the new health and social care levy.
We have made sure the NHS has the right level of resourcing to face the future with confidence, but we must also be alive to the consequences. The British people expect every pound spent to be spent well, and they expect us to be honest with them that every extra pound the hon. Gentleman calls for will be a pound less spent on education, infrastructure, housing and perhaps defence. I believe in a fair deal for the British people, and especially for our young people. We will be making plenty of changes alongside this funding.

Jonathan Edwards: One of the major problems we face in Wales and across the UK is the need to replace retiring GPs and dentists. There has been a welcome increase in the number of international medical graduates training in Wales, but the British Medical Association informs me that very few GP practices and dental practices in Wales are registered as skilled worker visa sponsors. Will the Secretary of State raise this with the Home Office to see what can be done to help GPs and primary care practitioners retain those international graduates to work in Wales and across the UK, if they so decide?

Sajid Javid: We are working with our colleagues in the Home Office on this and other skills and healthcare issues, so I can give the hon. Gentleman that assurance. He talks about the major problem he is facing in Wales, and that major problem is a Labour Government. I hope he agrees—[Interruption.] He is nodding.
Look at the performance of Labour in Wales, whether on health or education: the median waiting time for outpatients in Wales is almost double the median waiting time in England. People in Wales are waiting more than three years, whereas the longest wait in England is more than two years. Thanks to the covid recovery plan we set out in this House a few months ago, the number waiting more than two years has been slashed by more than two thirds in just four months, and it will be almost zero next month.
Thousands of people in Wales are waiting two or three years. In fact, one in four patients in Labour-run Wales are waiting longer than a year. In England it is one in 20, which is far too high and will be lowered, but in Wales it is one in four. It is not surprising the hon. Member for Ilford North had nothing to say about his colleagues in power in Wales.

Kate Hollern: rose—

Sajid Javid: I would like to hear what the hon. Lady thinks of the Labour Government in Wales and their abysmal performance when it comes to healthcare.

Kate Hollern: There is much better performance from the Welsh Government than from the UK Government. The Prime Minister promised 6,000 more GPs, which has not happened.
I wrote to the Secretary of State about Blackburn having only 33 GPs per 100,000 people, whereas the south-west has 73. I wrote to him about a young man whose cancer was misdiagnosed, but I have not had a response. I would say Wales is doing much better than the Secretary of State.

Sajid Javid: That is a very strange comment about the hon. Lady’s colleagues in Wales. Either she does not know or she is deliberately saying something she does not quite believe. Perhaps I can make her aware of the facts in Wales, where the number of people waiting more than two years for treatment currently stands at more than 70,000. That is more than three times the figure in England. That is more than three times the figure in England. It is at 70,000, and the hon. Lady seems to be very comfortable with that. I am surprised—it tells us all we need to know about Labour’s ambitions for government if she thinks that is acceptable.

Sarah Champion: rose—

Sajid Javid: Maybe the hon. Member for Rotherham (Sarah Champion) can tell us whether she agrees with her hon. Friend the hon. Member for Blackburn (Kate Hollern) on Wales.

Sarah Champion: The Secretary of State knows we are having a debate about the whole UK, but I am asking him specifically about England and his responsibility. Can he answer the original question from my hon. Friend the Member for Blackburn (Kate Hollern), which was about the Prime Minister’s 2019 commitment to 6,000 extra GPs? We know there are 1,000 newly qualified foreign GPs who are about to be deported by his Government, plus students who are unable to complete their studies because this Government are not providing them with the money for the final years. Under the management of the Secretary of State’s Government in the last decade, we have lost 4,500 GPs. Can he talk about what he plans to do to replace them?

Sajid Javid: I am happy to talk about that. Because of the record funding this Government have put in, both pre and post pandemic, we are seeing record increases in the workforce across the NHS. When it comes to GPs, since March 2019 we have seen an increase of some 2,389. On top of that, we have seen a further increase of more than 18,000 full-time equivalent staff working in other important primary care roles. That is in England—I am talking about England numbers.
Of course, we are working hard towards the targets we have set. We are also seeing more GPs in training in our medical schools than ever before, with more medical schools operating than ever before. I hope the hon. Lady will welcome that result and that investment.

Steve Brine: We are talking about GP and dentistry services today, but the wider primary care family includes community pharmacy and  ophthalmology, the vast majority of which are not NHS providers but operate under contract providing NHS services. In my excellent right hon. Friend’s second year in the Health Secretary job, will there be a ruthless focus on the wider primary care landscape? When it comes to prevention, surely those people must be the front door of the NHS to ensure that the system is sustainable in the long term.

Sajid Javid: Yes, absolutely. I know my hon. Friend speaks with great experience in this area. I am just about to come on to some of the changes we will be making to primary care, which I am sure he will welcome.

Andrew Selous: When the Secretary of State goes back to the Department, will he have a quick look at how it is that, in Leeds, north-east Lincolnshire, Fylde and Wyre and Stockport in the past six-and-a-half years, we have increased the number of GPs by between 18% and 22%? I am curious to know whether there are any lessons we can draw from those areas for the rest of the country. Will he ask his officials to look into that to see whether there are useful points for us?

Sajid Javid: I will, and I will get back to my hon. Friend on that issue with more detail. I hope he welcomes the investment we are seeing and the record numbers of doctors and GPs in training.

Richard Fuller: I know my right hon. Friend is coming on with some more ideas, but from talking to GPs across my constituency, one of the issues I have found is that, as we have diversified primary care staff beyond GPs to paramedics and others, the role of what might be called receptionists and telephonists has moved far more into triage. It is now a more complicated role. Is he attracted to the idea in the Policy Exchange document of creating an NHS gateway to provide more medically qualified staff at that first point of entry to GPs, but on a nationalised basis, available via internet, telephony and the cloud?

Sajid Javid: Yes, I am. I have seen the report my hon. Friend refers to and have discussed aspects of it with its authors, so the short answer is yes.

Imran Hussain: Will the Secretary of State give way?

Sajid Javid: I will later.
In terms of the changes we are making, let me first turn to primary care. The hon. Member for Ilford North, in his motion today, is calling on me to
“urgently bring forward a plan to fix the crisis in primary care”,
as he puts it. That is his motion. He is probably too busy supporting the strikers to have read my speech to the NHS Confederation last week. Had he bothered to listen to or read what I said in that speech, or the similar words from Amanda Pritchard, the chief executive officer of NHS England, he would have heard me acknowledge that our current model of primary care simply is not working. I have made no secret of that, or of my desire for change.
We are now working on a plan for change and, based on today’s motion, I will be glad to count on the hon. Gentleman’s support when we bring those plans forward, because what he has asked for, we are already doing. Our plans, for example, include a much bigger expansion in what our fantastic pharmacists can do. In fact, on the very day that I made that speech in Liverpool, we also announced a new pilot scheme to allow people with signs of cancer to be assessed and referred by pharmacists. That is yet another example of how we are working hard to enhance the role of our brilliant pharmacists and thereby freeing GPs to spend more time with their patients.

Imran Hussain: Thus far, if I have got this right, the Secretary of State has told us that there have been record levels of investment across our NHS services, including GPs and hospitals, and that any minor concerns that have arisen are because of the covid years. Does he think that the British public have been asleep for the last 12 years? Does he think that the British public will buy this? The stark reality on our streets—the Secretary of State may want to go and have a look—is as dire as it has ever been.

Sajid Javid: As I said—I am glad that the hon. Gentleman was listening—there have been record levels of funding in the NHS, and, as we set out in our spending plans, that will continue. But that is no thanks to the hon. Member for Ilford North and his colleagues, who all voted against that record funding. They wanted to deny those resources to their constituents. He should reflect on the impact of that had their wish gone through the House.
On the changes that we are making, we are going further, from improving telephone services to letting others such as nurses and pharmacists complete fit notes. Appointment numbers are already exceeding pre-pandemic levels—for example, in April, GPs and their teams were delivering 1.26 million appointments per working day. That is a phenomenal achievement, which the hon. Gentleman should be commending, not castigating.
The hon. Gentleman raised Wakefield and primary care. He was using dodgy numbers, so he was corrected by my hon. Friend the Member for South West Bedfordshire. He also gave out further dodgy information by somehow claiming that the King Street walk-in centre was under threat. I do not know if you have seen this in the by-elections, Mr Deputy Speaker, but the Labour party has a history of just making things up and creating fake news to scare local people. That is the respect that they show for local people. The walk-in centre has never been under threat. The local clinical commissioning group has confirmed that it has never been under threat. If he had any decency, he would stand up and withdraw his remarks. I give him that chance.

Wes Streeting: I would have thought that the Secretary of State would have learned by now that it is silly to give way to me when he makes these facile points. It is absolutely the case that the walk-in centre’s future was in jeopardy. It is absolutely the case that Simon Lightwood campaigned to save it. If that is what Simon Lightwood can achieve as a candidate, imagine what he will do as Wakefield’s next Labour MP.

Sajid Javid: The hon. Gentleman is now using the past tense. A moment ago, he claimed that it was under threat. He clearly has no issues with giving false information in this House. The truth is that, if Wakefield wants a better future, as everyone in Wakefield deserves, only one by-election candidate can provide that, and that is Nadeem Ahmed.
We intend to go much further to build a truly 21st-century offer in primary care. That includes Dr Claire Fuller’s independent review, which I found to be extremely valuable, and the changes that will stem from that as well as the many others that we will bring forward shortly. We will work with the population and the profession alike. The hon. Gentleman was right to focus on the importance of the profession, but he did forget to mention, as I referred to earlier, that since March 2019 we have more than 2,380 additional GPs in primary care, record numbers of doctors in training and more than 18,000 additional primary care professionals.
Let me turn briefly to the important steps we are taking in dentistry. Urgent care has been back at pre-pandemic levels since December 2020, and the 700 centres for urgent care that we set up to provide treatment for patients during this difficult period have helped thousands of patients across the country. At the start of this year we put an additional £50 million into NHS dental services, which boosted dental capacity by creating 350,000 extra appointments. Dentists are currently required to deliver 95% of pre-covid activity, and we are planning to return to 100% shortly. I commend all the dentists who are already achieving that.

Paul Blomfield: The Secretary of State referred to an additional £50 million. As he knows, the way in which that was framed made it difficult for dentists to draw down the money. Will he tell the House how much of it has been drawn down and used?

Sajid Javid: I do not have the exact figures to hand, but I know that millions of pounds were drawn down and used to deliver tens of thousands of appointments across the country. That made a huge difference to a great many people.

Greg Clark: The urgent care centres are an important innovation, but it is also important for them to be accessible throughout the country. There are seven in Kent, but the one nearest to my constituents is 33 miles away. Could my right hon. Friend intervene with the NHS in the south-east to bring about a more even distribution?

Sajid Javid: My right hon. Friend’s point is important and well made, and I will look at the issue closely and get back to him, if I may.
As we have already heard today—but it is such an important point—the challenge for NHS dentistry predated the pandemic. It is not just about the number of dentists in England, but about the completely outdated contracts under which they are working, which were signed under a Labour Government. [Interruption.] Labour Members do not like it, but it is true. These contracts mean that we are operating almost with one hand tied behind our backs. They do not incentivise prevention, they hold back innovation, and they mean that hard-working  families cannot get the dental services that they deserve. However, we will now be changing that; our work with the sector, along with the work of Health Education England on recruitment and retention, will be vital for the future.

Lilian Greenwood: Will the Secretary of State give way?

Sajid Javid: I will in a moment.
If there is one thing that unites all our work on primary care and dentistry, it is this. We are shifting to a new mode of operating—one that is about helping the whole population to stay healthy, not just about treating those who ask for help. We need to get to a place where we are healthier for longer, because freedom is hollow without our health.
Our new Health and Social Care Act 2022 is an important step in that ambition. Statutory integrated care systems will be responsible for the funding to support the health of their respective areas—not just treating people, but helping people to stay healthy in the first place. The Act also allows us to make safe and effective public health interventions such as water fluoridation, and we will set out further plans for that shortly.
Prevention, personalisation, people and performance: those will be our watchwords for modernising NHS services. They will sit at the heart of everything to come, from the health disparities White Paper to the update of the NHS long-term plan. While the Opposition continue to go off the rails, we remain firmly on track, laying down our plans to deliver a truly 21st-century offer for the profession and, most of all, for patients.

Several hon. Members: rose—

Nigel Evans: Order. As Members can see, there is a great deal of interest in this debate. I am not imposing a time limit now, although I—or whoever occupies the Chair after me—will obviously be free to do so later, but some discipline in this regard would be very useful. We will start with Paul Blomfield.

Paul Blomfield: A range of important issues has been raised by those on both Front Benches and in the interventions on them, but I want to focus specifically on NHS dentistry issues.
We have all had so many constituents contact us, and I would like to share a small selection of mine. One new resident to the city said:
“I moved to Sheffield earlier in the year. I am unable to register for an NHS dentist. I am being quoted waiting lists of eighteen months just for a check-up.”
Another wrote:
“My partner has been trying to get into a dentist for a check-up for around 18 months. We have rung every dentist within a 6-mile radius to be told they are not taking on NHS patients…and he will need to go private.”
One woman wrote to me:
“I have a MATB1 form entitling me to free dental care whilst I’m pregnant and for a year after birth. Unfortunately, I can’t use this as I can’t find an NHS dentist”.
A young mother told me:
“We’re told dental care is important and that we should get our children seen early and regularly. We moved to Sheffield in December 2020. I started to look for a dentist. I’ve been on a waiting list for a year with no progress.”
Another parent told me:
“Our son was referred for NHS orthodontic treatment by his dental practice in February 2019 at the age of 12. He has now been on the waiting list for 35 months and will turn 15 next month. He still has not had an initial assessment appointment.”

Lilian Greenwood: I thank my hon. Friend for giving way; the Secretary of State seemed to forget to do so. Does my hon. Friend share my concern that, even before the pandemic, the No. 1 reason for hospital admission among children aged five to nine was tooth decay? Is that not a shocking indictment of the failure to address health prevention and care for children and their teeth, and is it not a bit galling for the Secretary of State to suggest that this is the fault of the last Labour Government, when before the pandemic his Government had already been in power for 10 years?

Paul Blomfield: I thank my hon. Friend for that intervention, and she is absolutely right about how that highlights the crisis we are facing in NHS dentistry. That exists right across England, and it was interesting to hear comments from other nations, because significantly less is spent on dentistry in England than in Wales, Scotland or Northern Ireland. The Secretary of State blames everything on the contract, but the cuts to dentistry have been deeper than in the rest of the NHS, with spending a quarter less than it was in 2010, and I am not surprised that he made no mention of that.
Last Wednesday, I met our local dental committee to discuss the problem—dentists who are committed to their profession and to NHS provision, and who want a solution—and following our discussion, they commissioned a survey of waiting lists across the city. Some 37 practices responded, which is about half of the city’s providers, but only one practice could offer a waiting time shorter than a year. For 29% it was up to two years and for 32% more than two years. The most significant number was that 35% of practices were unable to add any patients to their waiting lists.
Across England, the number of dentists providing NHS services fell from 24,700 in 2019-20 to 21,500 now, which is a fall of 15% in just two years—

Maria Caulfield: indicated dissent.

Paul Blomfield: I see the Minister shaking her head.
However, there is provision for those who can pay. Healthwatch reported last year:
“Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week.”
That is adding to health inequalities, and it is not because dentists are reluctant to take on NHS patients, but because the system discourages them from doing so. We have patients wanting NHS dentistry and dentists wanting to provide it.
It is true that there are flaws in the 2006 contract. It is based on units of dental activity using figures from the two years prior to its imposition, which are now massively outdated. It contains huge discrepancies in remuneration  rates between practices doing the same work. There are penalties through clawback for underperformance for reasons beyond the control of practices, but no reward for overperformance. I see the Minister smirking, but she has been delivering this contract, and the Government have been operating within it for 12 years. There are limits on how much NHS treatment a practice can provide. That is because of quotas and the way that providers are contractually obliged to spread their NHS work. Dentists have a disincentive to take on new patients, who are more likely to have greater treatment needs, because the fee-per-item system was replaced with a system in which the same is paid for one filling as for 20.

Maria Caulfield: indicated assent.

Paul Blomfield: As the Minister is nodding, let us review the position as regards the contract. Back in 2008, the Select Committee on Health declared the system not fit for purpose. The then Health Secretary, Alan Johnson, responded by ordering a review of the system. In 2009, the Steele inquiry reported, and in 2010, we committed to reforming the contracts, but 12 years on, nothing has happened.
Ministers also blame covid. Clearly, it has had an impact; there was a backlog of 3.5 million courses of dental treatment after lockdown, and patients are inevitably presenting with bigger problems and increased need, which means longer appointments and extra work, for which dentists get no remuneration. The Ministers sitting on the Front Bench have presided over this flawed system. In quarter 4 of 2021-22, 57% of practices faced financial penalties for being unable to meet the targets that those Ministers effectively imposed; the problem is due to the additional infection prevention control requirements and the lack of adjustment to the remuneration system.
We have reached a tipping point for NHS dentistry. Unless the Government act, the number of complaints that all Members of Parliament are getting will only grow. More practices will move to a private model, which will add to the difficulties, because the system does not work for them.

Margaret Ferrier: NHS services are devolved, but many concerns about them are shared across the UK. Some of my constituents have concerns about the price of NHS dentistry offered through private dental practices, and about transparency in how final costs are calculated. Does the hon. Gentleman agree that, particularly given the economic climate, practices must give cost breakdowns before treatment begins, so that patients can budget and understand what they are paying for?

Paul Blomfield: We need transparency, and that starts with a new structure for remunerating dentists—a structure that no longer disincentivises them from taking on NHS patients, and that does not push them towards private care. If we do not make those changes, the system will get worse. Some 50% of NHS practices have already reduced their NHS commitment, and 75% are planning to reduce further their contracts. Patients will face frustration and all the pain involved in not accessing help when they need it. As others have commented, children’s oral health will be severely damaged. It is a disgrace—it shames the country—that last year, hospitals  in England carried out almost 180 operations a day on children to remove rotting teeth, and it cost the NHS more than £40 million. Those problems will impact those children throughout their life. Poor dental health is linked to endocarditis, cardiovascular disease, pneumonia, premature births and low birth weights, all of which add strain and cost to the NHS.
The good news is that there is an answer, but it is in the hands of the Government. We need to restore adequate funding to dentistry in England, and we need a commitment that the long-promised contract reform will take place. It must be real reform, and not tweaks at the edges. Otherwise, we face the slow death of NHS dentistry.

Peter Aldous: With regard to access to GP services, there is a significant challenge that must be met head-on. The solution must address patients’ ongoing concerns, involve long-term strategic workforce planning, and respect, not abuse, the GPs themselves.
The issue that I wish to focus on is access to NHS dentistry, which after 18 months retains the unenviable and scandalous position of being No. 1 in my postbag. It is quite clear that the situation is replicated for colleagues across the House. Access to NHS dentistry is a problem that has been brewing for a long time. It can be likened to a house built on shallow and poor foundations, which—with the earthquake of covid—have led to the house falling down.
The impact on people is profound: millions unable to find a dentist; thousands in agony, resorting to DIY tooth extraction; as yet untold numbers of undiagnosed mouth cancers; children suffering and having whole mouth replacements; and the poorest hit hardest. The solutions are fivefold: a secure, long-term funding stream; a strategic approach to recruitment and retention; replacement of the dysfunctional NHS dental contract; a prevention policy promoting personal oral healthcare from the cradle to the grave; and transparent and full accountability through the new emerging integrated care systems.
To be fair to the Government, measures have been put in place to address the crisis. Locally in Lowestoft, funding has been provided for an established dentist to attend to emergencies. The practice has responded heroically and prevented the system from collapsing. A new long-term NHS contract has been awarded to Lowestoft-based Dental Design Studio. That is welcome, although given that it was not possible to commission similar contracts elsewhere in Suffolk and Norfolk, there is concern that demand for NHS dentistry across the region will continue to outstrip supply, and that the new service could have a large and unserviceable catchment area.
The Government’s announcement in February of a £50 million dental “treatment blitz” was welcome, but there is concern that the take-up of that funding has been limited because dentists have been too overstretched to take on the extra work. In the long term, the fact that the feasibility of establishing a dental school in Norwich is being considered is also very much welcomed.
Those initiatives are a step in the right direction, but the underlying causes of the dentistry crisis are yet to be tackled. In May, the Association of Dental Groups’ report highlighted the emergence of dental deserts across the country, where there is almost no chance of ever  seeing an NHS dentist. There is a real risk of them merging to form an area of Saharan proportions. The British Dental Association is concerned that the negotiations to reform the NHS dental contract framework are yet to begin in earnest.
I have mentioned the importance of prevention. Back in February, I attended an event in Lowestoft at which community dental services and Leading Lives—a Suffolk-based not-for-profit social enterprise—launched a toolkit to help improve the oral health of young people with learning difficulties. Leading on from that, Lowestoft Rising, which promotes collaboration between statutory authorities and the voluntary sector, got together with local councillors and supermarkets to buy toothbrushes and toothpaste for primary school students. The initiative is to be applauded, but the feedback that I have received is that so much more could have been done if the group had not had to pay 20% VAT; surely this is a Brexit dividend that is looking us right in the eye.
As we have seen with the zero rating of women’s sanitary products, we now have more flexibility to vary our fiscal regime. If necessary, such a VAT exemption could apply to children’s dental products in much the same way as it does to children’s shoes. Children’s toothpaste and toothbrushes are distinct and different from those products used by adults. Such a strategy would embed good oral healthcare at an early age, and help to prevent the traumatic and expensive whole mouth replacements that hospitals increasingly have to carry out. Such a policy could form part of the new long-term plan for NHS dentistry that is so badly needed right across the country, and which I look forward to the Government rolling out at the earliest possible opportunity.

Paula Barker: I put on record that my husband is a senior manager in the NHS.
Dr Claire Fuller was commissioned by the Government to lead a national review of primary care. In her introduction to that review, she says that
“there are real signs of…discontent with”
general practice,
“both from the public who use it and the professionals who work within it.”
Every day, more than 1 million people benefit from primary care professionals and, by Dr Fuller’s own admission, primary care teams are over-stretched “beyond capacity”. Sadly, we have not heard anything today from the Secretary of State to address that issue.
GPs have been working in local communities for over 100 years. The concept has not changed: GPs are still based in their local community, with the only difference being that the buildings they work in are much more modern. GPs have now moved to a triage system, creating the perception that it is difficult to get a face-to-face appointment, and for some of my constituents that perception is reality. Bookable appointments have now moved to a longer lead-in time, from three to four weeks in advance to seven to nine weeks in advance. Nationally, there were half a million more appointments in January this year than in January 2020, but the number of GPs is roughly the same, despite the Government’s promise  in February 2020 that they would recruit 6,000 more GPs by 2024. More than two years down the line, we are simply no further on.
People are frustrated and angry that they are being contacted by GP surgeries to book in for a health check, yet cannot get to see their GP when they feel unwell. While it is undoubtedly important for GPs to carry out health checks, which can enable interventions, that cannot be at the expense of routine appointments. Those health checks are on an enhanced service contract, meaning that the GP is paid for every patient who takes them up. That is in addition to their normal contractual obligations, so it is no wonder that patients are frustrated. At the NHS Confederation last week—the gathering of more than 5,000 senior NHS managers and staff—which the Secretary of State said he attended, the single biggest area of concern was workforce.
We must ask ourselves why the guidance from NHS England predominantly concentrates on emergency care, rather than urgent care. It talks about how many people are waiting in accident and emergency, how many ambulances are delayed, and how many people cannot be discharged on time. Those are all important subjects, but that emphasis diverts people’s attention from the important point that the part of the NHS that deals with 90% of patient needs, GPs, only receives the crumbs off the table: 9% of the budget. It is time for the Government to deliver on their promises to recruit more GPs. The biggest threat to the NHS is crippling workforce shortages. If those shortages are not resolved, the Government will eventually start saying, “The NHS is failing.” That will, in turn, lead to the hedge funders coming in and taking over.
Our NHS staff are underpaid, undervalued and under-resourced, and are then blamed by this Government—this Government who have been in power for 12 years. Meanwhile, patients are struggling to get GP appointments and, often, when they call 111, they are advised to present themselves at A&E. This Government are hellbent on turning the NHS into the national hospital service, rather than the national health service. The model of primary care must change, and change for the better, to enable our constituents to access GP services in a timely and appropriate manner. Quite frankly, nothing less is good enough.

Richard Fuller: It is a pleasure to follow the hon. Member for Liverpool, Wavertree (Paula Barker). My observations are based on having, in the past six months, spoken and spent mornings with the people at about 11 of the 13 GP networks in my constituency and on some of their observations, which I have shared with the Minister previously.
Part of the issue in my area is that the population has grown so significantly. Since 2000, the number of patients per GP has gone up by about 40% in the constituency, which puts on significant pressure, which GPs are responding to, primarily by recruiting other direct care professionals, such as paramedics and various qualified nurses. That has a role in providing support to deal with the problems, but it has not overcome them. Significant efforts are being made to enable my constituents to  contact their GP. One interesting issue in those observations was that the practice’s choice of phone system had a significant effect. Practices that chose system A—I will call it that, as I do not want to say a bad word about a particular practice or phone system—would find that the response for the customers, the patients, was terrible. In effect, when 10 people were waiting, the 11th caller got a signal that the number was no longer obtainable. So they would then go to the practice. This was just after covid, so they would go to the practice, try to get in and there would be a big sign on the door saying, “No entry”. These very easy-to-understand problems cannot be solved by the Government but they have a direct impact on people’s experience of primary care.
However, there are aspects that can be affected by the Government. One of the biggest concerns in my area has been the level and pace of housing development and the absence of an infrastructure-first policy. Can the Minister update the House on her conversations with the Department for Levelling Up, Housing and Communities about implementing infrastructure-first? It means that, before a large housing development can take place, the GP services and the school places need to be there. We should not have people moving into their new houses on some of these estates and then finding that there are no GP places, school places and dentists. This was a manifesto commitment of my party and we should be putting it into law.
The comments by the hon. Member for Sheffield Central (Paul Blomfield) about dental contracts also go for GP contracts. There seems to confusion in the NHS—the Minister is clear that this is not really a Government responsibility—about whether there is value to the partner model among GPs, or whether we should be moving to a salary model and saying, essentially, that we are not going to pay extra for partners. This is an area where the Government need to set some direction of travel. It is an important direction to set for the NHS. I have my views, but I would be interested to hear whether the Minister believes that is something she can do.
Something that has been on my mind this week particularly has been the sclerotic process in NHS Estates and in other groups for getting primary care facilities built. The BBC’s “Look East” yesterday carried a story about the new primary care facility being built in Biddenham in my constituency. Eight years since it was first planned, we are hoping—fingers crossed, Madam Deputy Speaker—that that building will be commenced. That is because a lot of people had an interest. The GPs, the CCG, NHS Estates, the local authority, the housing developer and the developer of the facility all had an interest, but who was making the decision? The NHS needs to recognise that in the provision of services it has to be clear on who is saying yes, when, where and how.
I am grateful to the Minister for saying she will conduct a review of the impact, had infrastructure-first been in place. In my constituency, there is a cramped surgery in Great Barford that could move to a perfectly good, agreeable building opposite that would provide better facilities. Arlesey has had a significant increase in population. I visited its GP practice just two weeks ago. There is no air conditioning, and the doors mean someone could walk in on a GP during their session with a patient. The facility needs upgrading, so we need a  decision. I am told that my local authority, Central Bedfordshire Council, has the money ready to convert a site in Biggleswade to primary care, yet the NHS decision process is not making that happen. These planning processes need urgent attention from the Government if change is to be made.
We have talked about the diversity of primary care roles, which is one of the Government’s positives, as they have said they will increase the number of roles such as emergency care nurses and other types of nurses and paramedics. We saw the Government’s “Data saves lives” paper this week, on how the better use of data can assist in providing solutions. I take the shadow Secretary of State’s criticism of the NHS app. I was going to say it is 19th century, but it is certainly 20th century in its user-friendliness. What is the plan not only to harness data but to make it accessible and to put power in the hands of the patient?
People can do things with their health information, such as tracking how many steps they take each day. Diabetics can track information on testing. This is a world of improvement that empowers individuals in primary care. The first port of call in primary care provision is each of us managing our own healthcare. What better way to do that than following examples from the rest of the world through NHS applications?
Will the Minister update the House on the use of artificial intelligence and big data, particularly when it comes to pre-emptive screening? The Government are making a welcome investment in screening centres, but how are we harnessing all this medical data to the task of improving healthcare at a preventive level, rather than later in the day?
My hon. Friend the Member for Winchester (Steve Brine) has left, but he is absolutely right that the Government are on the right course in opening up more points of presence for primary care by bringing in pharmacies and screening centres, so that each of us can choose where we want to go to get some of the services we want. It is important that legislation and regulation follow as permissive an approach as possible. Let us focus regulations on the patient and patient choice, not on the provider and provider restrictions.

Cat Smith: It is a pleasure to follow the hon. Member for North East Bedfordshire (Richard Fuller). His points on planning resonated with me as a Lancashire MP. Where we see large expansions of housing that do not go hand in glove with expansions in GP practices, school places and public transport networks, it is hard to get buy-in from the current population in those areas for that expansion, with patients already struggling to get GP appointments.
When I was collecting my thoughts for this debate, I was worried that I might fall into the trap of talking about the huge number of constituents who get in touch with me daily about their frustrations with GPs and dentists, so I will begin by paying tribute to the GPs and dentists who work in my Lancaster and Fleetwood constituency. Having worked very closely with them for seven years, it is clear they are working to the best of their ability in a system that is, frankly, broken.
I will single out one GP in particular. It is always risky to start naming GPs because there will be someone I miss, but I pay tribute to Dr Mark Spencer. When he recognised the health inequalities, the differences in life expectancy and the increased number of cancers and other conditions among his patients in Fleetwood compared with patients in the rest of the borough of Wyre, he started an initiative called Healthier Fleetwood, which has the buy-in of our town, to promote healthier living and exercise. It is for that work that Healthier Fleetwood was awarded the Queen’s Award for Voluntary Service last month. I congratulate all the volunteers at Healthier Fleetwood and Dr Mark Spencer on having the initiative and foresight to do that. He established it because of those health inequalities, which are exacerbated when access to primary care is made difficult. The reality is that record numbers of people are waiting for care and waiting longer than ever before. When we say that people are waiting longer for care, it is important to remember that people are waiting in pain and in discomfort, and with conditions that become more severe and more difficult to treat.
Frankly, Tory mismanagement has left England with 4,500 fewer GPs than we had a decade ago. That is in stark contrast to what was promised in the 2019 Tory manifesto, which talked about 6,000 more GPs. Instead, we have 4,500 fewer. It is no wonder that patients are getting frustrated. Many of my constituents at the Lancaster end of my constituency started a Facebook group when they became frustrated with the telephone system of one medical practice in Lancaster. A lot of such issues are down to the fact that there is just not enough capacity to meet demand in that part of my constituency. My constituency feels like two stories. I get far more complaints and grumbles from the Lancaster end of my constituency about struggling to access GP appointments than I do at the Fleetwood end, and that is reflected in the number of GPs recruited.
When patients cannot access GP appointments, they are directed to urgent care or accident and emergency. That is financially illiterate. The cost of a GP appointment is roughly £39. If we direct someone to an urgent care centre, it is £77. If they end up at A&E, it is £359. By not funding and supporting primary care, and by not recruiting and retaining the GPs we need, it is costing the NHS more to deliver healthcare and making it more frustrating for my constituents.
Turning to dentistry, I spoke last week to a nursery teacher in my constituency who teaches a class of three and four-year-olds. They had been learning about dental hygiene and they were given a little toothbrush and toothpaste. She talked about their experiences of going to the dentist. She told me that hardly any of those three and four-year-olds had been to a dentist. That concerns me deeply, but it ties in with what I am getting in my mailbag as a constituency MP: constituents are struggling to get NHS dentists for their children. Adults, too, are struggling to get NHS dentists. One of the most obvious ways people fall out of having an NHS dentist is when they move house. I have many people who moved to live in my constituency from other parts of the country and tried to find an NHS dentist. Years and years later, they are still left waiting. I have examples of parents of school-age children who are still on NHS waiting lists to see an NHS dentist.
One of the most difficult advice surgery appointments I have ever had to sit through was when a constituent put on the table in front of me the teeth he had pulled out of his own mouth. That will, frankly, stay with me forever, but it should never have got to that point. As a result of that case, I have raised the issue of access to NHS dentistry many times in this Chamber, including at Prime Minister’s questions. Last year, 2,000 dentists quit the NHS.
The number of nought to 10-year-olds admitted to hospital for tooth extractions is going up. I looked up the statistics for my own area. There were 30 children in Lancaster and 40 children in Wyre under the age of 11 who had been admitted to hospital for tooth extractions. Of those children, 30 were five years old or younger. I have to say that we are getting something dreadfully wrong when it comes to NHS dentistry and access to NHS dentistry. If we do not get it right for children and babies, we are storing up a lifetime of health issues that will become more and more expensive to deal with and have a knock-on effect on wider health.
To wrap up, the Culture Secretary recently admitted that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” before covid hit. It seems that the Conservatives are now breaking their promise to hire the GPs we need and they are overseeing an exodus of NHS dentists. Those who cannot afford to go private are resorting to DIY dentistry or are being left in pain. Frankly, the longer we give the Conservatives in office, the longer our constituents will wait in pain.

David Johnston: All the GP surgeries in my constituency have worked incredibly hard throughout this period. I saw some of that up close when I was volunteering with the vaccination effort in the weeks that I could. The entire period has been a complete whirlwind for them, and they went straight back into there being a huge demand for appointments. I commend them for what they did during covid and what they are doing now.
The job of an MP is to not just champion but challenge. As every other Member of the House has, I have heard complaints about the difficulty of getting GP appointments, which I need to raise with surgeries. Those complaints are about getting an appointment at all, getting a face-to-face appointment, getting through on the phone, or—more for dentists than GPs—being able to register.
We know that the covid pandemic is a huge part of that problem, because we asked the public to stay at home and protect the NHS, which they did almost to a fault. I remember Ministers at the Dispatch Box, as the pandemic went on, pleading with people to come forward if they thought they had something. Understandably, however, people did not want to burden their GP or hospital. They are now rightly coming forward, and they may have had hospital treatments delayed again because of the backlog, so they are going to their doctor instead.
Sometimes, my constituents are unhappy about not getting face-to-face appointments; they dislike eConsult and telephone appointments. I have used eConsult  successfully, and I think it and telephone consultations have a place, but as a GP at one of my surgeries said, the risk with both of those is that GPs do not see the thing that the patient has not come in about. A patient may come in about their leg, and while they are there, the GP says, “Can I just have a look at the thing on your neck?”.

Emma Hardy: I completely agree with the hon. Gentleman’s point about GPs not being able to identify the issues that people have not come in for. Another thing that doctors can notice at face-to-face appointments is that someone is a victim of domestic abuse or violence.

David Johnston: I completely agree; the hon. Lady has made an important point. Sometimes, what people present with is not the biggest issue in their lives, and a skilled practitioner can uncover that.
As has been touched on, the issue is partly about telephone systems, bizarrely, as I will come on to, but it is also undoubtedly about a shortage of GPs. The Government have a grip on that: we have 1,500 more GPs now than in March 2019; 4,000 more trainees have taken up training places this year compared with 2014; and we have a health and social care levy which, as has been touched on, the Labour party opposes but which provides £12 billion a year to the health and care system, so there is more money to improve telephone systems and face-to-face appointments. Looking at the data this morning, we had 2 million more face-to-face appointments in April this year than in April last year, but we are still below pre-pandemic levels.
The complaints I get about dentistry are more about not being able to register anywhere. There is a particular issue with the promise that we make to pregnant women about being able to see a dentist, because even they cannot get registered. I met the Minister about that recently. The issue there is less about a shortage, as it is with GPs, and partly about the contract; there seems to be cross-party agreement that the 2006 Labour contract needs to be changed. I am also pleased that the Government will allow more internationally qualified dentists to support the dental system here.
There are two things that we need to get better at. One of them was touched on by my hon. Friend the Member for North East Bedfordshire (Richard Fuller). My constituency has also seen a huge growth in housing—we have two housing developments in Didcot alone, which will house 18,000 people—and the promised GP surgeries for these increased populations never arrive. As my hon. Friend said, we must get better at putting in the infrastructure first and at planning for the increased populations.
I shall finish on the second thing. Some Members may know that I worked in social mobility before I became an MP, running charities for disadvantaged young people. Unfortunately, the medical profession is the most socially exclusive profession in the country. Only 6% of doctors are from a working class background. A person is 24 times more likely to become a doctor if they have a parent who is a doctor. That is worse than politics, worse than the media, worse than the law, and worse than any other profession that we can think of. There are many reasons for that. It is about the allocation of work experience, how the recruitment process works,  and the fact that 80% of applications to medical school come from 20% of schools. There is a whole range of things.
The young people with whom I worked were eligible for free school meals. A very high proportion were from ethnic minorities. Medicine was the profession that they most wanted to get into. It was the most popular profession. On the one hand, we have a shortage of GPs, and, on the other, we have this incredible talent pool that finds that it cannot get into the profession.
One thing the Government might consider, as well as how we get the infrastructure in first, is how we make what is a hugely popular profession more accessible for certain groups of young people with whom I used to work, because, at the moment, they simply do not get into it in the numbers that they should, and, if they did, they might help with this GP shortage.

Stephen Morgan: I am grateful for the opportunity to raise the issues affecting my constituents in this important debate. Sadly, those issues are now becoming frustratingly commonplace for far too many people in Portsmouth, as record numbers of people are waiting for care, and waiting longer than ever before.
According to research by the Nuffield Trust, published in The Times last month, the figures are stark. Portsmouth is the worst affected area in the country, with just 40 GPs per 100,000 people. Meanwhile, one of the key GP practices in my city, the Guildhall Walk Healthcare Centre, closed in September last year, impacting more than 8,000 patients, many of whom are my constituents. Another GP service at the John Pounds Centre in Portsea also remains closed. I have raised concerns with local decision-makers about this, but it is clear that Government intervention is urgently needed to deliver the GP services that my constituents need and deserve.
It is a similar story with dentistry. A recent report from the Association of Dental Groups found that Portsmouth, at 42, has the seventh lowest number of NHS dentists per 100,000 in the country. Local Tory Ministers have claimed that the additional £6.8 million of piecemeal funding for dentistry in the region will help, but during the local dentistry forum that I convened with practitioners and representatives of the British Dental Association, they made it clear that it does not even begin to meet the scale of the challenge. They also underlined that there should be changes to rules and regulations on recruitment and retention to tackle this problem, as we have seen with NHS GPs.
I would welcome confirmation in the Minister’s response to the concerns raised by my constituents during my various lobbying efforts that reforming the NHS dental contract is under way, and that the BDA will be involved in its development. However, this cannot just be tinkering around the edges. My constituents need real action, and they need it, now.
In a survey that I conducted to hear the views of Portsmouth people, one respondent told me:
“I’ve had the same dental practice since I was born and now I don’t have a dentist at all because he went completely private due to Government contracts. I’m on universal credit and I can’t afford to pay private. My daughter is almost two years old and has never seen a dentist. It’s just shocking.”
Another said:
“My children and I travel to Watford every six months for our dental check-ups. There is no option to register with an NHS dentist in Portsmouth. I just hope none of us ever need emergency treatment.”
Possibly one of the most shocking examples of how bad things have got is that one Portsmouth resident had to resort to pulling out two of his teeth with pliers, after struggling to find an NHS dentist. In 2022, in one of the richest countries on the planet, no one should be forced to take such action because NHS services are hanging by a thread.” Portsmouth is now not just a dental care desert: it is a healthcare hell. It is time for the Minister to take her head out of the sand, listen to the people of Portsmouth, intervene to clear the backlog, develop a workforce strategy and finally deliver the NHS services my constituents expect and now desperately need.

Jack Brereton: NHS and care services have been under significant pressure over the last few years, due to the pandemic and now in restoring services as we open up. That includes dentist and GP services. I thank all of our NHS and care workers for all that they do and, especially, for all that they did during the pandemic.
Many of my constituents have contacted me because they are struggling to get GP appointments or to register for a place at an NHS dentist locally. I have been supporting many of my constituents to get access to GP services and to get into NHS dentists locally. That is something that we must address. The Government are prioritising £36 billion of additional investment to help to improve our health and social care services, which is very welcome. Primary care must be a key part of that investment and the improvements we need to see. I hope that, particularly with the reforms we are making in the NHS and the development of integrated care systems, we will see far more joined-up local healthcare that focuses on providing the seamless services patients need.
We also need to improve some of the quality issues. In some surgeries in Stoke-on-Trent we see very good quality of care, but the picture is far from uniform. We must also see the CQC taking a greater interest in issues of quality, such as whether someone can actually get an appointment, and not just the issues of safety that it focuses on at the moment.
Bringing decision making to a more local level for primary care will also ensure we can provide more joined-up and coherent health care services in our communities. For far too long, patients have struggled to access the healthcare they need, and both GP and dentist services have buckled under the strain of ever growing demand. Many GPs in Stoke-on-Trent have often raised with me the increasing challenges they face with greater demand for services and the increasing complexity of physical, mental health and wider social issues patients are presenting with. We need to fix the pressures we see in the system to create a healthcare system that shifts the balance far more towards prevention and earlier intervention. Whether it is physical or mental health, the more we can take action sooner, the better the outcome for the patient and the less likely more intensive and costly healthcare will be needed in the  future. To achieve that, we must see the NHS collaborating far more with wider healthcare partners, including pharmacies, local charities and others who have much to give in terms of preventive healthcare, especially for mental health. We very much need that support so that those GP and dentist services can improve.
I also support the work being done through primary care networks, which is bringing together key health professionals—not just GPs—to support GP services and patients. In North Staffordshire, we need to see the development of the four proposed integrated care hubs, especially in Longton, with the development of the next phase of the new Longton health centre. My hon. Friend the Member for North East Bedfordshire (Richard Fuller) made a point about the problems and processes in developing new buildings and new NHS assets. We have seen significant challenges in doing that, and it feels as though we have been talking about the issues for years. We have had consultation after consultation, but we seem no further forward. We have talked long enough about wanting to deliver those improvements, and we need to now get on and deliver them. They will bring all the local community NHS services together on one site, providing far greater healthcare services at the centre of the community and more walk-in services. I hope the Longton site might also include one of the new community diagnostic hubs—it is important that we deliver those across the country.
Those improvements to local community healthcare services will have the significant benefit of helping to ease the pressures on the Royal Stoke University Hospital as well as on local primary care services. This is not just about more money; given the record increases in the amount we are putting into the NHS and social care, it is vital that we continue to focus on the health and care workforce—something that comes up regularly when I talk to many of the healthcare professionals in the trust that runs the healthcare services in Stoke-on-Trent and Staffordshire.
Obviously, we cannot train new doctors and nurses overnight; it can take five years or more to do that. However, we are making good progress, with 4,300 more doctors and over 11,800 more nurses than this time last year. We also have 72,000 new nurses in training. We must build on that.
We must build and deliver the improved health and community health services that our communities need, and continue to attract more people to work in our health and social care system, creating more and more integrated healthcare services and supporting GP and dentistry services to meet the future health needs of our constituents.

Taiwo Owatemi: It goes without saying that GP surgeries play an essential role in our communities and in our NHS. They are often the first port of call for anyone in need of medical help, and it is the hard work of GPs that ensures we can all obtain advice, medicine and referral to other services. However, like much of the NHS, GP surgeries are overstretched, under-resourced and understaffed, due to more than a decade of Tory mismanagement.
Frustratingly, my constituents in Coventry North West are suffering the consequences of that. Constituents contact me every week, telling me about the difficulties they face in trying to access their GP. Like so many of the GP surgeries discussed today, surgeries in my constituency are made up of dedicated health and administrative staff who have been stretched often to breaking point and simply do not have the capacity, resources or staff they need to serve their patients.
I will focus on one example—a constituent who reached out to me about their 2-year-old daughter. Their daughter is non-verbal, has recently been having nosebleeds and is exhibiting symptoms of head trauma. Each day, my constituent wakes up and joins a queue to try to access a GP appointment. Even though they are often on the phone for hours, they are still not able to book an appointment. In fact, they have not been able to speak to anybody at all at the surgery. My constituent is understandably concerned for their child’s health and, like many others, is desperate to see their GP.
The difficulties facing our GP services are having a knock-on impact on the rest of the NHS. Patients unable to see their GP are more likely to request an ambulance or visit A&E. In the west midlands, we have seen ambulance waiting times skyrocket to more than 8 hours for some people. Another constituent raised a case where the patient had to wait more than two hours for an ambulance to arrive, even though they were experiencing a heart attack. If the Government do not get to grips with the scale of this problem, the entire NHS will have to pay the price.
Before being elected as the Member of Parliament, I worked in the NHS as a full-time cancer pharmacist, and I still regularly volunteer as a pharmacist at my local hospital, Coventry University Hospital in Warwickshire. That has provided me with first-hand experience of the dedication and hard work of everyone who works in our fantastic NHS.
It is important that the Government finally deliver a plan that lives up to the dedication of NHS staff, providing GPs and others with the resources they need to do their job. That is what our GPs deserve and it is what my constituents in Coventry are desperately asking for.

Dr Caroline Johnson: I draw the House’s attention to my declaration in the Register of Members’ Financial Interests. The debate is about GPs and dentists, and I will deal first with GPs. I pay tribute to the GPs who work in my constituency, and in particular those at the New Springwells practice and at Caythorpe and Ancaster medical practice, which have outstanding CQC ratings. I also pay tribute to the GPs who delivered the vaccine service. Not only did they work during covid with its challenges, but they delivered a vaccine service as well. They are a very hard-working, admirable group of people.
I agree with the Opposition that much of the overall problem with the NHS is a workforce problem. That is true. There are too many staff overall, and not enough of them are directly delivering or improving clinical care. We have expensive, very highly trained clinical decision makers being asked to do admin tasks that take them away from the clinical tasks that we are  paying them for and which we need them to do. That contributes to our longer waiting times. So we need to increase the number of doctors.
The Opposition are making a big point about 12 years, but it takes 10 years to train a GP, and it takes longer than that to train a consultant. So, actually, the shortage was created during Labour’s time in government and we are trying to fix it. That is indeed why the number of medical schools has been increased by five. I am pleased that one of them is in Lincoln, just outside my constituency. It is training a new generation of doctors who will provide services locally—people predominantly stay where they train—which will help the people of Lincolnshire to have more access to doctors. However, the Government should go further. In the year when we had challenges with A-levels caused by covid and more people than expected got the grades required to get into medical school, places were exceptionally increased. There are challenges with that—only so many people can get around a bedside and a patient will be happy to have only so many people listen to their heart or feel a lump or bump or suchlike—but, nevertheless, it has been managed for one year, and I think that it could be managed for more. The best thing that the Government could do for the health service in that regard would be to massively increase the number of doctor places. At the moment, we are turning away keen, enthusiastic potential young doctors doing their A-levels because places are so oversubscribed, but then we find that we have a shortage. That surely cannot be right.
I turn to ease of access. The Secretary of State mentioned making it easier for people to be referred into secondary care, which of course is a good thing, but we need to ensure that training is in place for that. Since I became a consultant, we have seen the number of patients referred into secondary care increase rather rapidly—certainly in the department that I work in—but the quality of referrals has not always been right, and undoing an unnecessary referral can be more time-consuming than just seeing the patient. We need to be mindful of the need to have clinical decision makers doing what they need to do and, as such, if we are to broaden the scope of people making referrals, we need to ensure that either referrals are done with specific guidance or that training is provided so they are good-quality referrals, and not those that add to waiting lists.
On dentistry, we have heard much talk about children having whole-mouth teeth extractions. Clearly, that is a horrific thing to happen—it is unimaginable, really, that a child needs to come into hospital to have all their teeth removed. I look to the Minister to tell us what she doing about that, because it is not, as some have suggested, all the Government’s or the NHS’s problem. In part, it must be about diet, teeth brushing and dental care—whether the teeth are being properly looked after—as well as potentially fluoride enhancement of water and the availability of dentists. Several stages need to be looked at in a more holistic way to prevent these children from having to go through such an awful experience.
In Lincolnshire, NHS dental care is good, but the service’s availability is relatively poor. In the last two years, only 41% of adults in Lincolnshire have seen an NHS dentist, and less than a third of children saw an NHS dentist in the last year. The Minister will be aware that I had an Adjournment debate on the topic in October. I thank her for her engagement with me since  and for her support in identifying potential solutions, as well as local dentists, the local dental committee, Professor Juster from the University of Lincoln and Health Education England for their time. They are just some of the people I have met to discuss Lincolnshire’s dental issues and how we can improve care.
The first thing to be solved is, of course, the dental contract. The contract was created by Labour in 2006, but I agree that we have had time and should probably have sorted it out by now. I raised that with the previous Secretary of State when I was on the Health and Social Care Committee in the previous Parliament. The contract pays for units of dental activity. There are three levels covering wide ranges of levels of care. Why Labour signed off on a contract that created such variability in both the value of a UDA and the amount of work required to be paid for one, I do not know, but it is human nature for someone to expect to be paid more if they have done more work, and that someone given the option of earning more for doing the same work will choose to do so. There, fundamentally, are the problems we have with the NHS contract. I look forward to hearing what the Minister is doing on that. I understand that she is in negotiations with dentists at the moment. I hope that she will be able to update the House on progress and that it will be good progress.
The second issue is geography. We know that our medical students predominantly stay where they train, and there is no dental school in the east midlands or in East Anglia. I am grateful to Health Education England and Ministers for discussions about solutions to this following my question at Prime Minister’s questions. There are a number of ways of resolving it. In the longer term, a dental school at Lincoln University would be a good way of ensuring that we have locally grown, locally trained dentists. The university is very supportive of that in the discussions, and indeed we have the support of all Greater Lincolnshire Members of Parliament for ensuring that this goes ahead.
I appreciate that it will take time to plan and deliver that, so in the meantime we need more dentists locally. The Minister and I have recently been talking about centres of dental development. The principle of a centre of dental development, which I would like to see in Sleaford, is that postgraduate training is delivered. It is attractive work for the sake of recruitment. People want to work at a centre because they get to deliver training and it is a more attractively remunerated job, but also, the postgraduate people being trained are immediately delivering care. Such a facility could be up and running within 18 months to two years and actively delivering care to my constituents, which is what I am looking for. I am particularly keen to see a centre located in Sleaford, because we have relatively few NHS dentists. We have great local schools, we have a fabulous community and we have great rail links, both north-south and east-west. What progress is the Minister making on these proposals?
Does the Minister have any update on what progress is being made on support for military families? I have a number of RAF bases, including RAF Cranwell, in my constituency. People who have moved around from place to place find that they have dropped off the list in one area and are struggling to get on to one in another. We have a covenant that says that we will ensure that people who are serving in our armed forces, and their  families, are not disadvantaged, but clearly in this regard they are. I would be grateful for those updates from the Minister.

Daisy Cooper: The Conservatives have been running our health and social care system into the ground for years. Covid has made an already bad situation worse, but it was already bad, and my constituents—patients and healthcare professionals—can really feel it. A constituent who is a professional chauffeur needs to provide regular medical assessment certificates to keep his job, but his GP is not doing them right now, so my team have had to work hard to make sure that his employer will not sack him.
Some of my constituents have managed to see their GPs. One has had a referral for chronic back pain, another for a diagnosis of breast cancer that needs treatment, but having had those appointments they then discovered weeks later that the referral letters were never sent. Another constituent who had a contraceptive implant has had some very severe side effects and wants to have it removed, but she cannot get an appointment. A constituent who contacted her GP to say that she was having suicidal thoughts was asked to fill out a form.
I was so concerned about these reports that I have been to visit our GP surgeries in St Albans. From the other end of the spectrum, it is incredibly shocking. The very second the phone lines open in a GP surgery, there are flashing lights on its big screen. At one minute past the time that its phone lines open, there are hundreds and hundreds of calls on the electronic board. Many of those phone calls are from very distressed callers who are in pain and very concerned. Many of the people at the counter—the receptionists at the other end of the phone—are receiving verbal abuse, and we know that GPs are receiving abuse in their surgery rooms behind closed doors as well. The BMJ suggests that violent incidents in GP surgeries have doubled in the last five years.
One of the GP surgeries in my constituency has now employed somebody on a full- time basis to do one job: to chase the local hospitals to send the letters so that the GPs can get the results that their patients need. We have heard Members across the House talk this afternoon about how fantastic it would be if we could use big data and if our constituents could become expert patients and use all the information collected on their phone, but frankly, at the moment, we are starting from a basis where we cannot even get a letter from a hospital to a GP surgery. It feels as though the entire system is creaking at the seams, and that is even before we get to the postcode lottery of the number of patients each GP has, or the length of appointments.
Members across the House have talked about the planning system and the fact that lots of new homes are often built in areas without the infrastructure to go with them. I wholeheartedly sympathise with the calls for new homes, but it seems crazy in the circumstances that clinical commissioning groups are not even statutory consultees for planning applications, for local plans or even for permitted development. It should be a priority for this Government to change that and make sure that CCGs have the right resources to respond to planning proposals.
Then we have the problems with dentists. Like many other Members use, I have constituents who have raised these problems. I have mothers with MAT-B certificates who cannot get dental treatment. I have parents whose children are developing gum disease, but they cannot get an appointment with their dentist. I have couples who have moved to St Albans and, because they have moved, cannot get an appointment with the dentist. The list goes on and on.
I have challenged the Minister before about the Government’s announcement earlier this year that they were going to give £50 million to dentists to create some emergency catch-up appointments. When the Secretary of State was challenged on this earlier this afternoon, he said that that £50 million had resulted in tens of thousands of new appointments. That was news to me. Earlier this year, I submitted a number of written parliamentary questions. I asked the Government how many dental practices had achieved the quarter 3 targets to make them eligible for this £50 million. The answer was that the Government did not hold that information centrally. I asked the Government how many expressions of interest had been received by the deadline of 3 January. The answer was that the Government did not hold that information centrally. I then asked the Government how many of those who had offered to carry out this urgent dental practice had been accepted. Again, the Government said that they did not hold that information centrally. So what has happened to that £50 million? How much of it has been drawn down?

Maria Caulfield: The hon. Lady will know, because she raised this in oral questions, that dentists return that data in quarters. We will have that data from the dental community by the end of June, and we will then be able to answer her questions. She knows that; she is making a political point here.

Daisy Cooper: I am genuinely incredibly grateful for that answer, because when I challenged the Minister on this last week I did not receive that answer. I am grateful to receive that response. I submitted a letter to the Minister—I think it was in April—and attempted to come to some drop-in events that were cancelled, so I am pleased to hear that that data will be provided by the end of June. However, my constituents in St Albans have seen absolutely zero appointments created from that money. Every dental practice has said that because of the way the funds have been set up, it has been impossible for them to apply for them. A number of other Members have raised that point.
The truth is that the Government have failed to recruit the GPs that we need. We have a retirement time bomb among our general practitioners, and we know that dentists are leaving NHS work as well. We need to see a serious plan from the Government so that everybody who needs to see a GP or a dentist can actually see one.

Emma Hardy: Before I turn to the main substance of my speech, I want to take advantage of the presence of the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is sitting there waiting to sum up the debate, by raising  a few points further to my earlier intervention on the Secretary of State. They concern the Medicines and  Healthcare products Regulatory Agency and the mandatory logging of mesh complications, which was a recommendation in the Cumberlege review. It has been more than a year since the most recent review, so I think that the Secretary of State may have been a little confused when, in his response, he referred to what was happening a year later. We have just learnt that the MHRA will continue the yellow card system, and will not be introducing mandatory reporting. I am keen to hear the Minister’s response to that point.
As joint chair of the all-party parliamentary group on endometriosis, I am also keen to hear from the Minister when we will see the women’s health strategy. Although that is not specific to the debate, it does relate to GP services. I should also like to hear her response to the anecdotal news I have been hearing that more appointments for gynaecological procedures are being cancelled than appointments for any other operations, and that gynaecological elective procedures are the least likely to take place. Again, it seems that there is a real issue surrounding women’s health.
I hope that the Minister will be able to address those issues of the women’s health strategy, endometriosis and mandatory reporting, but I will now turn to the main substance of my speech on access to GP services. Hull has only 40 GPs per 100,000 patients, which is one of the lowest proportions in the area. I want to draw attention to what two of my constituents have said. One, a gentleman called Rob Grimmer, told me about the birth of his granddaughter Nova. That was wonderful news, but unfortunately the family were unable to contact a GP surgery or get through to 111 when they needed to, and eventually they had to take the baby to A&E for treatment. The good news is that the baby is fine, but I am sure that Members can imagine the trauma involved. I have been a new mum myself, and I know that going to A&E with a new baby must be terrifying and very upsetting. I should like to hear from the Minister why we are seeing so many mums and babies having to go to A&E to obtain support.
Another constituent, a gentleman called Steven Draper, said that he waited three weeks for his grandson to see a GP. His grandson is only eight years old. What I really want the Government to take on board in this debate is the impact on children, and particularly on children’s education. If a child is repeatedly not feeling well and is unable to gain access to the services that they need, they will miss more school. The Department for Education says that attendance is very important and that it wants children to be back at school—Ofsted and a member of the Social Mobility Commission have also stressed the importance of attendance—but that does not seem to be joined up with children’s problems in accessing dental treatment and GP appointments, which lead to their having time off school.
I remember that when I was a primary school teacher there was a “brush bus”—I am not sure whether anyone else encountered one of these—which visited the school so that children could learn about the importance of brushing their teeth. There were even giant teeth in the classroom, which the children loved, so that they could see which bits get missed out during brushing. The problem is not just cuts in dental services, but cuts in public health provision, prevention measures and education. Long before the pandemic, we saw public health information services go.
Having teeth removed when a child is very small has an impact on that child’s education, not just in terms of time off but in terms of speech and language, and it will therefore affect phonics. It has a knock-on effect. I must emphasise to the Minister that we need to get this right. We are failing children when it comes to dental treatment. Indeed, we are failing people from cradle to grave, because we are also failing those at the other end of the spectrum.
This is another issue of which the Government should have been fully aware. They should have understood that people were ageing before the pandemic and that older people’s requirements are different. A few decades ago, most people in care homes had false teeth, which actually made them easier to look after, especially if they were dementia patients. I raised in Parliament, three or four years ago, the specific issue of dental care for people in care homes, particularly those suffering from dementia, who can find the whole procedure very traumatic while not understanding what is happening to them. This problem has existed for a long time, since way before the pandemic. There should have been plans that recognised that people were ageing, and ageing with their teeth, and would therefore continue to require dental treatment.
We are reaping what the Government have sown in the net spending cut of 25% between 2010 and 2025. We are reaping what they sowed in the five years before the pandemic, when the number of practices providing NHS dentistry fell by more than 1,200. I have huge sympathy for dentists and GPs in my constituency, and I want to add my thanks for everything that they do.
I was contacted by a local dentist about how she had been feeling. It was quite an upsetting letter. She had been pregnant and on maternity leave for part of the pandemic, but while she was pregnant she was trying to do her job in the middle of it. She was obviously worrying about her own baby, and she told me that she was having to give up being an NHS dentist because it was just not working out.
In her letter to me, she says:
“The Government have only offered £50 million in time limited funding which amounts to £40 a week per dentist. After a decade of savage cuts, it is no more than a sticking plaster of no consequence to the wider issues. I am likely going to go private this year despite enjoying helping high-need patients due to the Government’s poor contract and lack of funding.”
With respect, it is a bit odd for the Minister to blame the Labour party for not changing the dental contract when the Conservatives have had 12 years to look into it. I hope the Minister will urgently address the issue before more dentists step away from practice. That dentist had 3,200 patients in her practice, which means 3,200 more people now looking for support and help.
Unlike my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), I have not had a gentleman present me with his teeth, but I have had some really upsetting cases. A lady, who was pregnant and unable to access any other free NHS dental entitlement, said to me:
“Being entitled to free NHS dental care when you’re pregnant clearly isn’t an option any more. I think the situation needs to be addressed as I am sure it is not just in my area in Hull.”
She is absolutely right. Why is it that pregnant women are given free dental treatment? It is because pregnancy is likely to have an impact on teeth, so the lack of access  to free treatment is storing up problems in the long run. I have had countless emails from people telling me they have been struck off their dentist’s list due to not attending during a period of illness. Someone else told me that despite the swelling in her mouth causing immense pain, she had been dismissed as a patient and told that there was a six-to-12-month waiting list even if she was accepted again. Another who needs dental treatment and whose dentist had passed away told me:
“I complained to the ombudsman service. The ombudsman has today telephoned with the news that they are so overwhelmed with complaints that they are only allocating caseworkers to cases where death or serious injury has occurred. Even the ombudsman service cannot cope with the incompetence and failure that we have in the NHS dental service.”
Another gentleman wrote to me about how he broke his tooth in July 2021 and was still waiting in pain to have it removed in February 2022. The list of people who have contacted me to say they cannot find a dentist goes on and on. We are storing up more problems for the future. Someone else contacted me to say that their one-year old son—aged one, children are meant to have a dental check whether they have teeth or not—is unable to get a dental appointment. If we do not treat people when they are younger, we will create more problems in the future. Mismanagement of our NHS and our public finances, because of a lack of preparation and things not being thought through, means that everything costs more in the long run,
Our dental services are in crisis. We are facing a collapse that will take years to put right. Waiting lists, delays, cancellations and shortages are the real growth areas in Conservative backlog Britain. My constituents, along with those in the rest of the country, have had enough.

Rebecca Long-Bailey: According to the Association of Dental Groups, only a third of adults and half of children in England have access to an NHS dentist. As we have heard, the top reason for children being admitted to hospital is tooth extraction. It is 2022, not 1922. Back in 1947, when the NHS and NHS dental services were brought about by the then Labour Government, many of us naively thought that they would be around for ever, that we would always be able to access those services when we needed them. Unfortunately, we now see the return to the poverty-linked ill health that we saw in the 1940s.
As MPs, we hear heartbreaking stories. There was the Salford man with a badly infected tooth who could barely afford to live, let alone pay for private dental treatment. He could not find an NHS dentist who would take him on. He said to me that, had it not been for the fact that he was on anticoagulants, he would have pulled his own teeth out with a pair of pliers. There was the Salford woman with countless abscesses all over her jaw, and no money to go private. She was in acute pain and putting her life at risk from a spreading infection. She had been trying to get on an NHS waiting list for a dentist for over five years. There was also the Salford mother living on the breadline, yet forced to borrow and scrape together the money to go private. She told me that she had to pay £100 just to get on a dentist’s list. There are thousands of stories like this.
Recently, I asked the Government what data they held on the number of people trying to access an NHS dentist in Salford, such as the stories I had heard from my constituents. The Government confirmed that they held no data for my constituency or even across Greater Manchester. Frankly, that is staggering.
So what is at the heart of the decline of NHS dentistry? The British Dental Association details that chronic underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services.
On funding, in real terms, net Government spend on general dental practice in England was cut by over a quarter between 2010 and 2020. The £50 million that the Government have announced—as we have already heard today, it is difficult to access that at the best of times—will not even touch the sides given the amount of funding cut from NHS dentistry.
On the contract, the system in effect sets quotas for the number of patients a dentist can see on the NHS and caps the number of dental procedures they can perform in any given year. If a dentist delivers more than they have been commissioned to—say, to try to help a desperate patient in need of urgent care—that dentist is in effect punished. Not only are they not remunerated for the extra work done, but they have to bear the cost themselves of any materials used, laboratory work and other overheads.
It is no wonder that morale among NHS dentists is now at an all-time low, and we are facing an exodus of dentists from the NHS. We are seeing NHS dentistry deserts popping up all over the country, where constituents such as mine in Salford can only dream of trying to get on an NHS dentist’s patient list. Around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Staggeringly, for every dentist quitting the NHS entirely, 10 are reducing their NHS commitment by 25% on average, and 75%—75%—of dentists plan to reduce the amount of NHS work they do next year.
It is clear that we face a dental crisis and that the Government must urgently address it. There are a number of actions that I hope the Minister will take. First, they must reform the NHS dental contract with a decisive break from units of dental activity, a greater focus on prevention and the removal of perverse incentives.
Secondly, the Government must provide adequate levels of protected NHS dental funding to ensure investment in new and existing NHS dental services, and they must guarantee the long-term sustainability of NHS dentistry for all who need it.
Thirdly, NHS dentistry must be given the status it deserves. That means sitting right at the heart of local NHS commissioning, rather than being treated as an afterthought—a luxury service, as it were, which is how many seem to perceive it.
Finally, the Government must build and properly fund historic public health commitments to prevention. As we have heard—from Conservative Members, actually—this is a crisis in NHS dentistry, but many of the factors that contribute to this crisis are directly related to poverty, people’s diets and the amount of money they have to spend as a family on oral health  and hygiene.
We are in the midst of a cost of living crisis as well as a dental crisis, and the Government need to be doing far more to support families to make sure that they have enough to live on and a decent range of food that provides them with the nutrition they need in order to have healthy teeth. We naively thought that poverty-related ill health, rotting teeth and gum disease had been consigned to the history books when NHS dentistry was established in 1948, but this Government wind the clock back day after day and those afflictions are now back with a vengeance. NHS dentistry hangs by a thread. The Government have a moral duty to stop the rot today because rotting teeth come from a rotting Government. I hope that the Minister will change my mind.

Imran Hussain: For many people living in Bradford, being unable to get an appointment with their GP for days or weeks, or being unable to see an NHS dentist at all, is one of the most depressing issues they face—if not the most depressing. Although such a scandal in our healthcare system is of course unacceptable anywhere, the harm that it is causing in Bradford, where we face especially stark health inequalities and where people are dying a decade earlier and facing a higher rate of preventable diseases, is particularly damaging.
It seems that the Government either do not understand or just do not care. Earlier, the Secretary of State opened for the Government. According to him, we have had record levels of investment, the Government are now planning many initiatives, and any concerns were entirely a result of the two years of covid. Of course, everybody in this Chamber would accept that the NHS, GPs, dentists and all the health services faced pressures during covid. I do not think anyone is denying that. The Secretary of State said to the shadow Minister, “You supported us during that period”. Of course we did. We were a responsible Opposition and of course we ensured that any pressures during a very difficult period could be alleviated. But to say that the issues have suddenly resulted from that period is simply untrue, and Ministers know that it is untrue.
The second assertion—those who were in the Chamber will recall that I pressed the Secretary of State about his record investment in the NHS—was that of course there was record investment, but let us look at that investment. Let me go to my district, to Bradford, and see the record investment that Ministers and the Secretary of State want to boast about. Frankly, they live in some parallel universe, because we do not see the effect that they come here and tell us about. In Bradford, one of the most deprived districts—more than 50% of the deprivation in my constituency is in all the top 10 deprivation indices—child poverty is now at a record high because of those on the Government Benches. Nearly 50% of children in my constituency today live in poverty because of the draconian, ideological cuts made by this Government over the past decade. I have said this in the Chamber many times: people who live in the inner cities are likely to live 10 years less than if they live in the leafy suburbs, which are far more affluent and, frankly, get more investment.
What does the record investment that the Secretary of State and Ministers tell us about equate to in Bradford terms? They tell us that, on average, we will get £4 per  patient more than the rest of the country, even though we have the levels of deprivation, poverty and health inequalities that I have gone through. But actually the situation is worse, because even that £4 of investment that they tell us we are getting is fudged figures and smoke figures, because in real terms, if inflation was to be counted, we are getting £3 million less than we had before this Government came to power. On average, we have more than 2,800 patients per GP, whereas the national average is 2,100 patients per GP. If anywhere should be seeing this record investment, it should be in places such as Bradford, but are we seeing it? How does that equate? The hon. Member for St Albans (Daisy Cooper), who is no longer in her place, talked about the stark reality on the ground. This is why I say that Ministers are living in a parallel universe, because the stark reality on the ground is not as they see it. Most people simply cannot get GP appointments. People start ringing first thing in the morning and are on hold for hours on end. Many people will then have to wait until the next day. Getting through to a GP practice on the phone takes days on end.

Sarah Owen: When the Minister comes to her feet, I am sure she will say that X number of people have been able to access a GP, but have they been able to access their own GP? We have heard time and time again from health professionals how important continuity of care is. Does my hon. Friend agree that this is not just about seeing any old GP—it is about someone seeing their own GP?

Imran Hussain: I absolutely agree with my hon. Friend, who makes the point that I was coming on to raise. Her Luton constituency is not dissimilar to mine. With a single GP having 2,800 patients, it is obvious why those patients are not getting to see their GP. I could spend a long time in this Chamber going through constituency cases that I have recently dealt with. Indeed, I have done that in the past and those cases are on the record. Let me cite just one case today. An elderly lady in her 90s had to go to hospital and was then told to go to see her GP. Her son tried day after day to make a simple GP appointment for her. She had multiple health needs. My office had to intervene and even we were unable to secure a GP appointment for her. People are having to go through this ping-pong of not getting a GP appointment and then going to A&E as they have nowhere else to turn.
I am grateful because I did ask the Health Secretary about Bradford and urgent treatment centres, and he did favourably say that he would arrange a meeting with the Minister for Health, the hon. Member for Charnwood (Edward Argar), who joins us now, at precisely the right time. I look forward to that meeting because that is a way through and I am grateful for that offer. But the reality remains that the Government’s promise—or the points the Secretary of State made earlier today—is not apparent on the streets. People continue to suffer, they cannot get GP appointments and they have nowhere else to turn. That point has been made eloquently by a number of Members.
At least, after days and weeks of trying, people are able to get an appointment with a GP. Many Members have talking about issues with joining an NHS dentist. There is more chance of finding gold bricks on the street, or of finding the parallel universe that Government  Ministers live in, than there is of getting on to the list of an NHS dentist. People simply cannot get NHS dentists, and we have heard accounts today of how they are being forced to carry out DIY operations at home, without anaesthetic or any medical care—I have come across such cases in my own constituency—because they have no other option. Frankly, as the fifth largest and richest economy in the world, it is shameful that people are having to resort to DIY treatment at home. Again, that is happening on this Government’s watch.
I have been in this place since 2015, and every time we have a debate about NHS dentists or GPs, Tory Members refer back to the Labour Government of 12 years ago. I remember that when I was growing up, under a Thatcher Government, GP practices were back-to-back houses on terraced rows without adequate facilities. The last Labour Government brought in record investment, gave us state-of-the-art health centres, and reduced health inequalities and child poverty. That was all under a Labour Government, but Tory Members cannot pretend that the Labour Government of 12 years ago are somehow responsible for the issues we face today. The Whips are not in their place, but I say to the Tory Whips, “Please do your Members justice and remove that line from the long-standing script you have for them”, because it is becoming embarrassing when Tory Members stand up and say, “12 years ago, there was a Labour Government, so it must be all their fault.” They can use that line for a year or two, but unfortunately, in nobody’s world can they use it for 12 years. Tory Members need to start understanding that.
Can we expect any more from this Government? This is a Government who believe people choose to be poor—they have said so in this very House and on TV. This is a Government who believe people should work extra hours and do more, and that those who are forced into poverty are not forced, but have chosen poverty. The reality is that this is a Government who could not care less about people in Bradford who continue to suffer. [Interruption.] The Minister chunters from the Front Bench; she will have time to address those points when she responds.

Maria Caulfield: I would be interested to hear the hon. Gentleman’s opinion on the position in Wales, which was set out in the Secretary of State’s opening remarks. Wales faces exactly the same pressures, and its waiting times are actually worse than England’s. What is the hon. Gentleman’s reason for why the Welsh Labour Government are in exactly the same position as this Government?

Imran Hussain: Again, the first defence is “Labour 12 years ago”; the second defence is “Labour in Wales”. The point about Labour in Wales has already been appropriately addressed, but the Minister’s job is to address those issues in England. Rather than address those issues, she thinks that saying “What about Labour in Wales?” somehow provides a cover, an umbrella, and a defence against the incompetence that exist across our health sector. That does not wash with the British public, because they have not been asleep for the past  12 years. They have noted the devastation that the Tory Government have caused in our communities, and the  back-door privatisation and ideological agenda they have brought to our health service. I have said it before, and I will say it again: people will repay them with interest at the ballot box.

Mohammad Yasin: It is a great honour to follow my hon. Friend the Member for Bradford East (Imran Hussain). I have received a steady stream of complaints from my constituents in Bedford and Kempston about excessive GP and dental waiting times. They are angry, frustrated and bewildered that the system is failing them, but there is also a sense of fear that the NHS they knew and loved is no longer there for them.
For over a decade, Opposition MPs have warned about the impact of underfunding the NHS and of the harmful top-down reforms; and about what would happen if the Government failed to take seriously the recruitment, retention and training problems for GPs and dentists. We expect an announcement on dental contract reform before the summer recess, but we need more than short-term quick wins to reform that fundamentally flawed contract. For patients across the country to see any real difference in the level of access to NHS dentistry, we need genuine, meaningful contract reform, yet formal negotiations on such reform have yet to begin.
Over recent months, I have met GPs across Bedfordshire, who have all made it clear to me that there is a crisis in general practice. In Bedford, there is only one GP per 2,500 people, which makes it one of the places worst hit by GP shortages in the whole country. Those shortages are leading to staff burnout and poor retention, and unfortunately are hitting patients in need of care hardest. Surgeries are being assimilated into trusts to try to rectify those issues, but as GPs take on more acute care from hospitals that face their own backlogs, surgeries are seeing increased demands from patients.
Worryingly, we are also seeing escalating levels of verbal and physical abuse directed at GPs, dentists and surgery staff. Much of the current narrative, which is actively encouraged by those on the Tory Front Bench, is that GPs are hiding behind remote appointments and are working part time. That is not true; the truth is very different. GPs who are considered part time often find themselves in their surgeries covering full-time hours due to the growth in administrative work.
GP bashing only leads to more doctors and their staff leaving the profession. With too few doctors available to treat patients, that combination has led to growing waiting times for patients to access appointments. The BMA says that doctors are feeling a sense of “moral distress”, because they cannot give patients the care and support they deserve.
Now that covid restrictions have eased, it is, of course, vital that in-person appointments are there for those who need them. By enabling some remote consultations, many surgeries aim to clear the backlog of appointments more quickly and free up capacity to treat patients who need physical appointments. Covid accelerated and exposed the existing crisis, but the Government know that we were well on our way to this point before the pandemic.
The Government may be trying to patch the funding holes with emergency money, but too often they fail to invest in sustainable long-term plans, such as the well-thought-out Kempston health hub bid that they rejected.  We urgently need a convincing plan to get to grips with the serious workforce crisis and get the NHS back to how it was under the last Labour Government.

Margaret Greenwood: People are struggling to get GP and dentist appointments, and this is a crisis of the Government’s own making. In their 2019 manifesto, the Conservatives promised 6,000 more GPs in England by 2025 but, in his evidence to the Health and Social Care Committee last November, the Secretary of State said when asked about this target:
“I am not going to pretend that we are on track when clearly we are not.”
Dr Richard Vautrey, chair of the BMA’s GP committee, said at the time:
“The bottom line is we are haemorrhaging doctors in general practice. While more younger doctors may be choosing to enter general practice, even more experienced GPs are leaving the profession or reducing their hours to manage unsustainable workloads.”
Recent statistics show there are now fewer than 6,500 GP practices in England, compared with more than 8,000 in April 2013. As of April 2022, there were the equivalent of 1,622 fewer fully qualified, full-time GPs in England than in 2015. All this has happened on the Conservatives’ watch.
The lack of access to GPs has implications for patient safety. We know early diagnosis is important, but it cannot happen if people cannot see a doctor. People who cannot get an appointment, or who face long waits to get one, are at risk of not getting the referral they need, which can lead to health problems down the line. Those who are able to get an appointment but are seen by a GP who is suffering stress and burnout due to the pressures of the job are also put at increased risk.
A poll of nearly 1,400 GPs by Rebuild General Practice in March found that 86% of those surveyed say they do not have enough time with patients, and it found that GPs are seeing, on average, 46 patients a day. This is a matter of great concern, as the safe maximum number of daily appointments, as recommended by the BMA, is 25. Doctors are seeing nearly twice the safe maximum number, which is bad for patients and unfair on very hard-working GPs.
People in Wirral West tell me they have ended up going to A&E because they cannot get an appointment with their GP, which puts more pressure on an already stretched A&E. A recent study by the Royal College of Emergency Medicine showed that, in 2021, an average of 1,047 people a day were waiting more than 12 hours in A&E from their time of arrival, which is wholly unacceptable. People need to be able to access GP services when they need them, both for their own health and to keep the pressure off A&E.
The Conservatives are overseeing an exodus of dentists from the NHS, which is forcing people to choose between paying to go private and going without dental care at all. Research by the British Dental Association shows that around 3,000 dentists in England have stopped providing NHS services since the start of the coronavirus pandemic, and that for every dentist quitting the NHS entirely, 10 are reducing their NHS commitment. It also shows that 43 million NHS dental appointments have been lost since the start of the pandemic, which is  equivalent to well over a year’s worth of NHS dentistry in pre-covid times. This enormous backlog continues to grow.
The British Dental Association is clear:
“NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.’
A constituent, a dentist in Wirral, has told me that people from Manchester and Lancashire are calling the practice to ask if they can register. The Government have told me that there are no geographical restrictions on the practice a patient may attend, which completely misses the point. Services should be available locally. Who wants to travel for an hour, two hours or longer when they are in desperate pain and need to see a dentist urgently?
Shockingly, 50 children in Wirral under the age of 11 were admitted to hospital for tooth extraction last year. That is bad enough, but the figure is much higher in many parts the country. The Conservatives’ failure to fix this crisis is putting the oral health of children at increased risk. No child should have to end up in hospital because they are unable to get the dental treatment they need.
The Government need to come forward urgently with a plan to fix the crisis in GP access and dentistry. Failure to do so has serious and painful implications for patients.

Holly Lynch: In the time that I have this afternoon, I will focus on the incredible difficulties my constituents have had in accessing NHS dentistry. As others have said, the pandemic has intensified problems in our dental healthcare system, but the architecture for those problems was in place long before the pandemic. We have heard from the British Dental Association that more than 43 million dental appointments were lost between April 2020 and April 2022, including more than 13 million appointments for children.
Helen Hunter, chief executive of Healthwatch Calderdale, which serves my constituency, has argued that the pandemic has made
“a significant problem even worse”.
At a national level, dentistry is now the No. 1 issue raised with Healthwatch. Almost 80% of people who get in contact with the organisation say that they find it difficult to access dental care, with the General Dental Council saying that almost a quarter of the population—24%—report having experienced dental pain in the last 12 months.
Healthwatch Calderdale has been relentless in its campaigning on this issue. In August last year, it contacted every dental practice across Calderdale to establish whether it was willing to accept new NHS patients, whether it would register a child and whether it was offering routine appointments. Every dental practice told Healthwatch that it could not currently register a new NHS patient of any age. When neighbouring Healthwatch Kirklees did the same, it had the same outcome.
As others have said, having people get in touch with us, as MPs, because they cannot find a dentist is one of the most difficult issues that we are asked to contend with from a local casework perspective. As things stand, there is simply nothing we can do to help people. We  speak to the CCG, we call the dentists, we speak to NHS England and we write to Ministers, but the capacity is not there because the system is so broken, and no amount of pleading from local MPs can fix it for someone in need.
One constituent rang more than 30 dental practices, each of which told them that it was not accepting new NHS patients. My constituent could find no available practices in Halifax and none across Calder Valley. There was not even a dental practice available in Huddersfield or Bradford. We have already heard a passionate argument from my neighbour, my hon. Friend the Member for Bradford East (Imran Hussain). People are encouraged to look further afield, but those practices are overwhelmed with their local demand, so going further afield does not solve the problem. When we have made representations on behalf of patients in Halifax, we have been advised to search for practices in Leeds, Barnsley and Wakefield. Members can imagine making that kind of journey to get to a dentist. Parents of children, for example, are asked to book appointments that do not impact on the school day. For them to be asked to travel 20 miles to try to speculatively get an appointment is just not good enough.
I recently met Rachel Dilley, chief operating officer of Town Hall Dental, which has dental practices in Calderdale, to gain a better understanding of the problems that they are experiencing. Town Hall Dental has had to set up a charity alongside its private and NHS work to help to fund dental treatment, check-ups and the vital oral cancer checks that dentists undertake. That is all necessary, but it goes underfunded. I commend Town Hall Dental for its charitable and fundraising work, but that should not be necessary.
In my desperation to get Government to act, I started a petition on my website for constituents, calling on the Government to improve NHS dental care provision in Halifax, so that residents can access care easily and locally. The petition has more than 500 signatories, and I will be presenting it in the Chamber in the days to come.
One local parent said to me:
“I have been making weekly phone calls to all Calderdale dentists in an attempt to (at the very least) get my children into a dentist as I value oral health greatly. However, I am yet to be successful in my goal which is becoming quite time consuming, as I now have a three year old daughter that has never even visited a dentist and 4 other children who have been without a check up in 5 years. That is half a decade with zero dental care.”
Another constituent got in touch to tell me that, since they had had no luck finding a nearby practice that would take NHS patients, they were forced to make a five-hour round trip to the Berkshire dentist that they had been registered with prior to moving to Halifax.
Such long waiting periods are also undermining what is functioning within the system. One constituent had to wait five years just for braces. When they finally got their braces, the orthodontist informed my constituent that they would need four teeth taken out. Having tried everywhere to find a dentist, my constituent told me,
“if I don’t find one, I won’t be able to keep my braces on.”
It is just madness. Another of my constituents, who was already dealing with mental health challenges, had been in pain and needed urgent medical treatment. Her friend  got in touch to tell me that she was sent to A&E and advised she needed to see a dentist. She ended up seeing an NHS dentist in Elland for treatment, but they would not see her on the NHS and told her she had to pay for private treatment. Her friend could not believe that that could be allowed to happen, saying:
“How can this be the case when a young lady with mental health issues and no savings, in a medical emergency, needs to seek help from me, her friend to pay for urgent dental treatment”?
During the pandemic, I organised a roundtable discussion with local dentists, who shared with me the perverse ways in which NHS contracts are broken down into units of dental activity. The UDA system is just not functioning. If we needed any further confirmation, data from the BDA reveals that around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Perhaps even more worryingly, for every dentist leaving the NHS entirely, 10 are reducing their NHS commitment by 25% on average. A BDA survey from May 2022 shows that 75% of dentists plan to reduce the amount of NHS work they do next year, with almost half planning to change career, seek early retirement or enter fully private practice.
That is where the current, broken contract system has got us. I urge the Minister, if she believes in being able to see a dentist on the NHS, to scrap the current system, start again and find a way to make the contracts work. One third of people see a dentist privately, but 71% of those people say they do not do so through choice. As the cost of living crisis continues to affect families, more and more people will be priced out of private treatment by inflation and rising bills and living costs.
My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) earlier described this as an existential crisis, and it very much is. I say to the Minister, “Please, please fix it.”

Mary Foy: There are many issues that my constituents are experiencing when trying to access GP services, but I will focus my remarks on the crisis affecting dentistry across England and the impact that is having on people in Durham. I want to start by paying tribute to the dentists, dental nurses and other key workers in practices in County Durham and across the country.
Sadly, despite the brilliant work of dental workers, NHS dentistry is on the brink of collapse. Whether in Bowburn, Brandon or Pity Me, my constituents are struggling to access the dental services they need and deserve. Four in five people who contact Healthwatch say they have found it tough to access timely dental care, while tooth decay, as we have already heard, is currently the most common reason for hospital admissions among young children. In County Durham, 245 children under the age of 10 were admitted to hospital for tooth extraction between 2020 and 2021. Thousands of children are currently in pain, distracted as they learn, in pain as they eat and struggling to sleep because they cannot access vital treatment. Let that sink in.
Why is it so difficult to access NHS dental appointments? Because dentists are being driven away from NHS dental services en masse. A recent poll of dentists in England found that 45% had reduced their NHS commitment since the start of the pandemic, while 75% were likely to reduce their NHS commitment in the next 12 months.  Alongside that, an alarming 87% of dentists say they have experienced symptoms of stress, burnout or other mental health problems in the past year. In total, 3,000 dentists have moved away from NHS work completely since the start of the pandemic.
As the British Dental Association has said,
“This is how NHS dentistry will die”.
The warning is not sensationalist; it is the reality that dentists and their patients in Durham are facing. This crisis is entirely avoidable. It is certainly not the fault of our rail workers striking today, as the Secretary of State would like us to believe—utterly disgraceful. What planet is he on when he talks about record funding? That is certainly not the case for NHS dentistry, which has faced cuts unparalleled to the rest of NHS services. In real terms, the Government’s net spend on general dental practice in England was slashed by over a quarter between 2010 and 2020, while the Government’s £50 million injection into dentistry will fund less than 1% of the appointments we have lost since March. In fact, the British Dental Association estimates that it would take £880 million a year to restore dental budgets back to the level when Labour left office.
Let us be clear: these issues will hit the poorest in our society the hardest. For many, the fees for private dental treatment are simply unaffordable. As one desperate constituent put it to me, “I can’t afford private treatment, so what on earth am I supposed to do?” There will be terrifying delays for children, adults and the poorest among those in County Durham, and I am sure across the whole country. Children in deprived areas are already three times more likely to have hospital extractions, while oral cancer, which kills more people than car accidents in the UK, is significantly more likely to affect those in our poorest communities. Dentists are frequently the first to spot health problems. Without access to regular appointments, our least well-off constituents will continue to be more likely to develop serious health problems than the wealthiest in society.
I take this opportunity to remind the Minister that it is the Government’s job to reduce health inequalities, not widen them. As elected representatives, we are responsible for protecting and improving access to key public services for our constituents. It is time the Government stopped treating dentistry as an afterthought and urgently took action to widen NHS dentistry. For my constituents in Durham, this crisis in healthcare is very much at the forefront of their minds.

Feryal Clark: I thank Members from across the House for their contributions this afternoon. I want to praise some of the powerful contributions we have heard during the debate.
My hon. Friend the Member for Sheffield Central (Paul Blomfield) raised the absolutely ridiculously long waiting lists for NHS dentists in his constituency. It is worrying to hear that pregnant constituents cannot even register with a GP, let alone see one. Shockingly, he mentioned the children in his constituency, one of whom has had to wait 35 months to see an orthodontist. He rightly pointed out the issues with the dentist contract, which is disincentivising dentists to take on NHS patients, and reminded us of the last Labour Government’s commitment to reforming it.
We heard from the hon. Member for Waveney (Peter Aldous), who set out the NHS dentistry crisis in his constituency. He rightly set out that many dentists are simply not drawing down on the £50 million Government funding that the Minister says is being used. He set out, in comments I really welcome, the issue of our crumbling primary care assets. I thank him for raising the issue of the NHS app and I could not agree with him more. When are the Government going to move the app into the 21st century? Finally, he mentioned that patient choice is really important. I welcome those comments.
We then heard from my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), who mentioned the huge number of constituents who are frustrated with their current lack of access to primary care. She mentioned her constituent Dr Mark Spencer, who set up Healthier Fleetwood to tackle health inequalities. I, too, send my thanks to him. She also mentioned that demand is not being met in primary care, and she rightly mentioned the Government’s financial illiteracy, with patients being forced to go to A&E instead of having their demand met in primary care.
On dentistry, my hon. Friend set out how children in her constituency cannot access NHS dentists and the shocking experience of constituents who are resorting to DIY dentistry, as was raised by many hon. Members. She rightly set out that the Government are getting it very wrong. She also set out the Government’s shocking record on GP recruitment and the exodus of NHS dentists. Most shockingly, she mentioned the number of children aged zero to 10 years old who are admitted to hospital for tooth extractions in her constituency in just one year: 30 in Lancaster and 40 in Wyre, of whom 30 were aged five or younger. If that is not a wake-up call for the Minister, I do not know what is.
So many shocking incidents and examples—too many to mention—were raised today, and I thank all hon. Members for sharing their constituents’ experiences. Primary care is in crisis—I know it, Members across the House know it, and the public know it—but the Government continue to bury their head in the sand.
As we have heard from right hon. and hon. Members, our postbags are packed with letters from constituents who are desperate for someone to listen to them. There is the person who cannot get an appointment to be prescribed the medicine they need to manage their chronic pain. There is the person with MS who cannot get an appointment to be referred to a specialist whom they desperately need to see. There are the patients in Wakefield, where every day a child under 11 is taken to A&E for tooth extraction because they cannot see an NHS dentist.
We have heard Ministers come to the Dispatch Box time and time again to lay the blame of primary care’s problems at the door of the pandemic. No doubt, it has had an impact, and we should pay tribute to our amazing NHS staff who have done admirably in the face of an immense challenge, but blaming everything on the pandemic will no longer cut it.
Going into the pandemic, the Government’s preparations were “wanting and inadequate”—not my words, but those of the Culture Secretary. When the argument is not even washing with the Cabinet, how does the Minister expect the public to believe it? After a decade of Tory mismanagement, we went into the pandemic with record waiting lists and staff shortages of 100,000. It is not just  that the Tories did not fix the roof when the sun was shining; they dismantled the roof and removed the floorboards. The impact of that became plain for all to see.
The Government promised to recruit an additional 6,000 GPs by 2025, yet we now have more than 1,500 fewer full-time equivalent GPs than when records began in 2015—that was in the Minister’s response to one of her colleagues in April. Given that we have heard from the Royal College of General Practitioners that the average cost of GP appointments is £40 and that an A&E visit is £359, that is not just an access problem but financially untenable. Even the Secretary of State admitted that the target is beyond reach. With a fifth of GP practices having closed or merged since NHS England was formed in 2013, the pattern is becoming clear. The Government have been completely incapable of delivering for more than a decade, creating not a covid backlog but a Conservative backlog.
On dentistry, the situation is a national scandal. Over a third of adults and half of children do not have access to an NHS dentist and, with paying to go private simply not an option for most, we have children being admitted to A&E for tooth extraction on a daily basis and others choosing to take matters into their own hands with DIY dentistry, as we have heard from hon. Members on both sides of the House. In Wakefield, as of 2020, almost a quarter of children have tooth decay before the age of three—double the national average of 11%. How on earth can that be tolerated in 21st-century Britain? Thanks to this Government’s complete inability to come up with a solution, we are not just facing a return to Dickensian Britain; we are already there.
I am sure that the Minister, when she responds, will roll out her usual line about the crux of the issue being the 2006 dental contract, and how this is all Labour’s fault. I am sorry, but after 12 years of Tory Government that simply will not wash. The issue of access is only getting worse, with figures obtained by the British Dental Association showing an overall drop of 22% in the number of patients seen by NHS dentists in England from March to April. In the Minister’s own constituency the figures was 34%. How can she expect dentists across England to have confidence in her when she clearly does not even have the confidence of those in her own patch? If that is not evidence that dentists are leaving the NHS or cutting their commitment, having no confidence that her promised reforms will ever be delivered, then what is? If her idea of tackling the problem is to run scared from even talking to dentists at a conference, then there really is no hope.
This must change. We need a Government who listen. We need a Government who act. Quite frankly, we need a Government who care. This Government have run out of road, have no ideas left and are holding our country back. A Labour Government will give our NHS the staff, equipment and modern technology it needs to deliver for patients. It is time for the Conservative party to move out of the way and let us get on with the job.

Maria Caulfield: It is a pleasure to close this debate after a wide range of speeches. First, I  will put my hands up and acknowledge that there are challenges and difficulties in primary care and dentistry. We heard that from Members from Scotland, Northern Ireland and Wales, which shows that all the devolved areas of healthcare are facing exactly the same challenges.
I start by thanking all those in primary care and dentistry for going above and beyond, and not just during the covid pandemic but as we are coming out of it, whether that was dentists providing urgent treatment under difficult infection control measures, or GPs delivering millions of vaccinations while continuing to see patients. We are now seeing not only the routine number of patients we would usually see, but the two years’ worth of patients who stayed at home and protected the NHS, as we asked them to do.
Despite the Opposition’s protests, we are making progress and record numbers of patients are being seen—higher than ever before. We are seeing 1.3 million patients per working day in primary care. That is a 44% increase since last year, and 63% of those are seen face to face. As my hon. Friend the Member for Wantage (David Johnston) said, that is 2 million more face-to-face appointments than this time last year.
There are record numbers of GPs, despite what Opposition Members have said—nearly 36,000 full-time equivalents, which is 1,400 more than in March 2019. We are going further, with 4,000 more trainees taking up GP training this year, providing more GPs for the future. We have delivered 30 million extra GP appointments, as part of our manifesto commitment to deliver 50 million more GP appointments. As an indication of the scale of the record numbers of patients coming through the system, we are seeing 11,000 cancer referrals a day, which is a record high.
How are we supporting GPs? We had the £250 million winter access fund, which helped deliver a cloud-based telephony system that some practices took up, which is transforming how patients can get through to their practices. If practices did not take up that offer, NHS England is rolling out the system across the country, so I urge them to look into it because it delivers better capacity, allowing patients to get through to make their appointments. It bought extra hours to pay for staff to do more shifts and see more patients, and it paid for more physical space in practices.
We have delivered 13,000 of the additional 26,000 roles pledged in our manifesto—paramedics, practice nurses, primary care pharmacists, physios and OTs working in primary care. We are tackling the bureaucracy that GPs face, and laid a statutory instrument to address fit notes to allow professionals other than GPs to return people to work. We have developed the pharmacy consultation system, whereby 111 or GP receptionists can refer people directly to a pharmacy for first-line care. We are developing a renewed GP contract, opening up access at weekends and in the evening. We are expanding community pharmacy with our work on Pharmacy First to deal with minor ailments, blood pressure checks and discharge medicine services.
We are also tackling the infrastructure problem through the Levelling-up and Regeneration Bill whereby health and local government will work hand in hand to tackle the issues my hon. Friend the Member for North East Bedfordshire (Richard Fuller) raised. We are also delivering—

Daisy Cooper: Will the Minister give way?

Maria Caulfield: No, I will not.
We are also delivering zero tolerance to abuse through the Police, Crime, Sentencing and Courts Act 2022. Labour talk the talk, but it was those of us on the Government Benches who voted to double the maximum sentence for those who abuse our emergency care workers. Labour actually voted against giving the Bill a Third Reading. That tells us all we need to know.
With the time I have left—

Holly Lynch: Will the Minister give way?

Maria Caulfield: I will not give way. Members did not—

Hon. Members:: Give way!

Eleanor Laing: Order. If the Minister is not giving way, she is not giving way.

Hon. Members:: Frit!

Maria Caulfield: I am not frit, but I am conscious that another debate follows this one. I did not want to play politics, but if Opposition Members want to, I will give them politics.
The Labour party is against everything and for nothing. We have not had one suggestion from Labour or the Lib Dems. They are full of complaints without a single solution. We know that the shadow Secretary of State was busy over the weekend deleting his past misdemeanours, but he cannot delete Labour’s misdemeanours with the NHS. As Davina McCall would say, let’s have a look at their best bits. There are the PFI contracts that they mysteriously introduced—£1.4 billion a year is still going to private investors because of the deals made under a Labour Government. Full Fact confirmed that £57 billion will be spent in total on those PFI deals.
Moving on to the 2004 GP contract negotiations, evening and weekend cover was taken away, handed to primary care trusts and given to private companies. Changes to the law in 2007, voted for by Labour Members, allowed bigger businesses to buy up GP practices, resulting in the evidence we saw on “Panorama” last week. The top hit is the 2006 Labour dental contract—

Wes Streeting: Oh, here we go.

Maria Caulfield: The hon. Gentleman may say, “Here we go,” but Opposition Members acknowledged this afternoon that the Labour contract was causing the problems. We are getting on with dealing with that.
My hon. Friend the Member for Waveney (Peter Aldous) asked what progress is being made. We put the negotiations to the BDA on 24 March and made a final offer—[Interruption.] They don’t want to listen, Madam Deputy Speaker; they don’t care. We put the final offer to the BDA on 20 May, and we are waiting to hear back. We are reforming the dental contract, which perversely disincentivises dentists to take on NHS work.
To correct the hon. Member for Portsmouth South (Stephen Morgan), he did not host that dental summit; it was my right hon. Friend the Member for Portsmouth  North (Penny Mordaunt), who invited me. The summit came up with a solution, and I am meeting her team so that we can work on that and take it forward.
In addition to the dental contract, we are reforming how we take on dentists from overseas. We consulted the GDC, which recently ran a consultation, and we will be laying legislation to give it powers to allow dentists to come here more easily—[Interruption.]

Eleanor Laing: Order. I can hear what Members are saying, and it is just not right. It is simply rude when we are supposed to be listening to the Minister.

Lloyd Russell-Moyle: And I think she could do better.

Eleanor Laing: Order. You are not saying anything while you are sitting down—nothing! I call the Minister.

Maria Caulfield: Thank you, Madam Deputy Speaker. Labour Members do not want to hear about the work that the Government have been doing. They are just too busy criticising.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) also mentioned the work that we are doing on centres for dental development. We are already working in places such as Cornwall to start training more dentists in those areas. In Norfolk and Norwich, we have met representatives from the university. The meeting was led by local MPs who brought people together to set up centres. We have also been working in Lincolnshire as well.
We are empowering the dental workforce by changing and upskilling dental technicians, dental nurses, and dental assistants to be able to take on more work. We are also tackling the issue of clawback.
You would think, Madam Deputy Speaker, that this is just an issue in England. If we look at Labour-run Wales, we find that the Community Health Councils have acknowledged that Wales is also facing a crisis of access to GPs, and that patients are waiting more than an hour to get through on the phone only to find that there are no appointments left.
The number of dental practices in Wales has fallen—from 1,500 in 2019 to 1,389 last year. In the past year alone in Wales, there was a 71% drop in courses of dental treatment. Why is that happening under a Labour Government? [Interruption.] I have given the answer. Opposition Members are too busy talking, Madam Deputy Speaker. They do not want to hear the answers.
Opposition parties need to be honest with the public. Whether we are talking about Scotland, Wales or Northern Ireland, we are all facing the same challenges. [Interruption.] No! There is a Labour-run Government in Wales and an SNP Government in Scotland. [Interruption.] The Opposition continue to play politics, but we are getting on with the business of reforming and making those changes. They have no solutions, no answers and no ideas. It is this Government who are delivering the changes. We are being honest with the British public that we will face challenges, but we are making the changes to improve access to both dental and primary care services.
Question put and agreed to.
Resolved,
That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.

Adviser on Ministerial Interests

Angela Rayner: I beg to move,
That the following Standing Order be made:
“(1) Following any two month period in which the role of Independent Adviser to the Prime Minister on Ministers’ Interests remains unfilled, the Public Administration and Constitutional Affairs Committee shall appoint a specialist adviser, entitled the Adviser on Ministers’ Interests, whose role shall be to advise the Committee on the effectiveness of the Ministerial Code and on any potential breaches of that Code.
(2) The Adviser may initiate consideration of a potential breach of the Ministerial Code, and shall consider any such potential breach referred to him by the Public Administration and Constitutional Affairs Committee.
(3) When considering potential breaches of the Ministerial Code, the Adviser may advise the Public Administration and Constitutional Affairs Committee on the appropriate use of its powers to send for persons, papers and records in order to secure the information needed to consider any such potential breaches.
(4) The Adviser shall submit a memorandum to the Public Administration and Constitutional Affairs Committee reporting conclusions relating to a potential breach of the Ministerial Code.
(5) The Adviser shall have leave to publish any memorandum submitted to the Committee under paragraph (4) which has not been published in full and has been in the Committee’s possession for longer than 30 sitting days.”
What a pleasure it is to open this debate, especially as it is with the Minister for the Cabinet Office and Paymaster General. I will call him my right hon. and learned Friend now because I see him more often these days than I see my friends. It is always a pleasure to stand opposite him. Hopefully, he will be able to give us some answers today, so that we can build on that friendship.
The truth is that, to lose one ethics adviser is an embarrassment, but to lose a second, just days after the Prime Minister’s anti-corruption tsar walked, too, means that it has become a pattern—a pattern of degrading the principles of our democracy; a pattern of dodging accountability; and a pattern of demeaning his office. The Prime Minister has now driven both of his own hand-picked ethics advisers to resign in despair—twice in two years. It is a badge of shame for this Government and it should be for the rogue Prime Minister, too. If he was capable of feeling any shame, Lord Geidt has described the resignation as a “last resort” that
“sends a critical signal into the public domain.”
Well, he has certainly sent that signal, Madam Deputy Speaker. In his damning resignation letter, Lord Geidt spoke of the “odious” and “impossible” position that he had been put in. He said that the Prime Minister had made a “mockery” of the “Ministerial Code” and that he would play no further part in this. It was not about steel at all; it was about this Prime Minister’s casual and constant disregard for the rules. Lord Geidt could not stomach it any longer, and I do not blame him. To this Prime Minister, ethics is a county east of London.
The truth is that the Prime Minister behaves as though it is one rule for him and another for the rest of us, because that is what he thinks. Scandal after scandal has hit him and his Government. His previous adviser on ministerial interests, the respected Sir Alex Allan, resigned when the Prime Minister chose to excuse the  Home Secretary despite the fact that she had breached the ministerial code by bullying civil servants. Sir Alex could not stand by and condone bullying, and the Prime Minister was more than happy to. After losing his first independent adviser, it took five months to appoint a new one—five months during which ministerial misconduct was left unchecked, creating a huge backlog of sleaze and misconduct by Tory Ministers. Lord Geidt himself complained about this backlog.
This House should not tolerate a repeat performance. We cannot endure another five months with no accountability in Downing Street. We cannot endure another five minutes of it. Since Lord Geidt resigned, the Government have refused to confirm if or how his ongoing investigations will continue. I hope my new right hon. and learned Friend the Minister can tell us today whether the investigation into the shameful allegations of Islamophobia experienced by the hon. Member for Wealden (Ms Ghani) will now be concluded. She was due to meet Lord Geidt on the day that he resigned, but the Government have been silent on the issue and have failed to say anything about what will happen when any further suspected breaches of the ministerial code occur.
Take, for example, reports that the Prime Minister, while Foreign Secretary, tried to make an inappropriate appointment to his own office. He reportedly spoke to his aides about a taxpayer-funded position—just another case of dishing out jobs to those close to him. Lord Geidt has suggested that such allegations are ripe for a new investigation, and I agree. As everyone knows, I love a letter, but who should I write the request to? There is no ethics adviser in place to hold Tory Ministers to the standards the British public expect. We all know that Ministers will not do it themselves. Under this Government, more rule-breaking is simply inevitable, unfortunately. Lord Geidt has already said that his role was “exceptionally busy”.

Jeremy Wright: I happen to agree with the right hon. Lady that there should not be a long gap before the appointment of a new independent adviser, but let me put something else to her. Two weeks ago, when she opened a debate on a similar subject, she prayed in aid extensively the Committee on Standards in Public Life, of which I am a member, as she knows, and she did so rightly, in my view. Does she accept, though, that she cannot do that today, because her motion does not accord with what the Committee on Standards in Public Life has said? We believe that the ministerial code must remain the property of the Prime Minister because that is how it derives its authority, and it therefore makes sense that the adviser should give advice to the Prime Minister and not to any Committee of Parliament, however eminent. How is it that the Committee on Standards in Public Life was so right two weeks ago but wrong now?

Angela Rayner: I commend the work of the Committee on Standards in Public Life and its report, which I absolutely agree should be implemented in full, but that is not what has happened: it was cherry-picked in what the Government have done with the changes to the ministerial code. This is an emergency measure because we cannot carry on for months and months without the adviser being present, as I am sure the right hon. and learned Gentleman agrees. I hope the Minister comes to the same conclusion. I have written to him and had a  response today in a written answer about when the appointment will be made. I understand the right hon. and learned Gentleman’s position and what he is saying, but I say categorically that I absolutely agree with the report and want to see it implemented in full.

Aaron Bell: I have sympathy with the thrust of the right hon. Lady’s motion in that we do not want a long delay, and I am sure the Government have sympathy with it, too—I am sure the Prime Minister would like to appoint as soon as possible—but the rest of her motion seeks to create a new Standing Order. Traditionally in this House, the Procedure Committee would advise on Standing Orders, so would she be amenable, should the Opposition motion pass today, for the Procedure Committee to look at this as a matter of priority, given the timelines involved?

Angela Rayner: I thank the hon. Member. The thrust of what I am trying to do today, and hon. Members need to understand this, is just to have some probity, standards and ethics we can all agree on. One of the things I think is very damaging, and this has been very damaging for all hon. Members of this House, is conduct that the public out there see as inappropriate not being scrutinised and dealt with. This does not just affect the Prime Minister; it affects each and every one of us in this place, so I am happy to continue further dialogue to ensure we get to such a point. However, this is about making sure that something happens now, because we have seen conduct and standards from this Prime Minister that, quite frankly, I have never seen before from any Prime Minister of any political persuasion.

David Linden: In response to the point made by the hon. Member for Newcastle-under-Lyme (Aaron Bell), I accept that the Procedure Committee does have a role—and I was a member of the Procedure Committee—but given that Brexit was supposed to be about Parliament taking back control, there is absolutely nothing at all disorderly about the motion on the Order Paper for Parliament to take control and set up its own Standing Order. The right hon. Lady is right: the problem is that the Prime Minister’s behaviour will almost certainly start to be interpreted as a plague on all our houses, and that is why Parliament must support this and must vote for this motion tonight.

Angela Rayner: This is about us trying to make sure that we do take back control, and also that we gain the respect of the public. Quite rightly, when they elect us and bring us into this place, they expect us to have the highest standards. Especially when we create the laws that they have to follow, they expect us to have the highest possible standards.

Liz Saville-Roberts: Of course, the resignation of yet another ethics adviser will do little to quieten public concerns that there is something very rotten at the heart of this Government. Next week, I will be presenting a ten-minute rule Bill that would make lying in politics illegal and give our constituents confidence that we are serious about forcing a change of culture within our political system. Does the right hon. Member agree with me that the present culture is corroding trust in politics and democracy?

Angela Rayner: I absolutely agree with the right hon. Member that trust is being corroded in politics, and I do not like that. I do not like that for any of us hon. Members in this place, because I believe that the vast majority of Members who come to this place do so for great public service. Therefore, when hon. Members do not behave to the standards I think the British public expect of us, that actually makes it difficult for all of us. The hon. Member for Glasgow East (David Linden) mentions the procedures of this place, and sometimes it is challenging for the public when they see people “inadvertently mislead” the House. The public do not always see it as “inadvertently misleading” the House, and therefore they do not understand exactly why we have such a debate on that matter.

Geraint Davies: Would my right hon. Friend accept that the debate between an independent appointment and an appointment by the Prime Minister has been cast into a different light by partygate, by the appointment of somebody’s girlfriend for £100,000, by the breach of international law with the Northern Ireland protocol and even by what has happened on steel tariffs? Therefore, there is a compelling case for independence or at least for Parliament to decide on those issues, not the Prime Minister, who people, frankly, do not trust for good reasons.

Angela Rayner: Absolutely. During Lord Geidt’s time as ethics adviser, he was swamped—swamped—with allegations of ministerial misconduct. During his session with the Public Administration and Constitutional Affairs Committee, referring to the ministerial code, Lord Geidt said that
“as you look through the calendar, a great deal of the year has potentially had the Prime Minister in scope.”
It is astonishing that we are in these circumstances, but we are where we are.
The Prime Minister’s official spokesperson has refused to confirm when the independent adviser will be replaced, or even if the independent adviser will be replaced at all. It is pretty clear that, if the Prime Minister had his way, he would dispense with the nuisance of transparency and the annoyance of accountability altogether.

Robert Buckland: I agree with the right hon. Lady about the need to appoint a new adviser but I have looked carefully at her motion, which talks about an adviser. What would the status of that adviser to the Committee be? Would they be an employee of this House? If they were an Officer of this House, there would be an obvious conflict between their duty to Parliament and any involvement they might have in Government affairs. Does she not see that that is quite a problem that needs to be addressed by her and the motion?

Angela Rayner: I do not see the wording of the motion creating a conflict or causing problems in that way. It will allow us to have the scrutiny and probity that we need, because the Government at the moment are not forthcoming in giving us the assurances that I have tried outside this place to get on whether we are going to get a new adviser. That is the thrust of what I am trying to do today. I can see that Members are passionate about this issue, and I am happy for them to work with us to try to get there. I am sure that my friend the Paymaster General would be willing to do that as  well. We all want to see standards in public life, and Ministers of the Crown in particular need to have that authority when dealing with matters of office so that the public can have confidence in them. That is what this motion is about today.

David Linden: Does the right hon. Lady understand the irony of Conservative Members complaining about a conflict of interest when the Prime Minister’s own chief of staff, whom he appointed, is simultaneously an MP, the Chancellor of the Duchy of Lancaster and the chief of staff—a role that is traditionally undertaken by a civil servant?

Angela Rayner: This is part of the problem. We all need to have confidence that processes are being followed and that there is accountability. Nobody is above the law in this country, but the Prime Minister seems to think that he can be. It is astonishing that we are in those circumstances.

Karin Smyth: I thank my right hon. Friend for introducing this debate. I think the point she was making very well earlier in response to questions from Conservative Members who have been good lawyers in their previous life is that the thrust of what she is trying to do today is to suggest that we all in this place want to do better, and that we are willing to look at ways to do better. If the thrust of this motion does not meet that high standard, it is open to Conservative Members who have experience and expertise in this area to suggest other ways of doing this, perhaps by bringing forward amendments, and to work with the Opposition in that way. I think she is saying that that is something she welcomes.

Angela Rayner: The last time the Paymaster General was sent here to defend the indefensible, he claimed that the Prime Minister’s recent changes to the ministerial code represented
“the most substantial strengthening of the role, office and remit of independent adviser since the post was created in 2006.”—[Official Report, 16 June 2022; Vol. 716, c. 429.]
He must think I was born yesterday. Removing any reference to honesty, integrity, accountability and transparency is not strengthening standards; it is cherry-picking parts of the recommendation and watering it down before our very eyes. Within hours of the Paymaster General saying those words at the Dispatch Box, No. 10 was already refusing to repeat his commitment to that system—a system that the Prime Minister himself had put in place just weeks before.
Now the Government do not even deny the plans to abolish the role of the independent adviser entirely. Today, the Minister answered my written question about his plans to fill the post and said that the Government were “taking time” to consider the matter. Just how long does he expect us to give him? Should we expect half a year of sleaze and scandal without accountability? For more than a year, the Prime Minister used Lord Geidt as a human shield, citing his independence and integrity as the Government desperately staggered from one scandal to the next. Now the Culture Secretary takes to the airwaves to mock and belittle him. That is what they do to decent people. Conservative Members who continue to prop up this Prime Minister and keep his self-preservation society afloat would do well to note that. That is where this House must come in.
Labour’s proposal today would put this Prime Minister into special measures, where he needs to be. If he fails to appoint a new independent adviser, the Public Administration and Constitutional Affairs Committee will have the power to appoint one. We will give the Committee the proper powers to launch investigations, to send for papers, persons and records, to report on breaches and to make its judgments public. This Prime Minister has ridden roughshod over the rules. He will not show any regard to ethics, but this House can do that today. The motion before us is a limited, simple measure to address any refusal by the Prime Minister to enforce the ministerial code by allowing Parliament to step in.
Of course, we would like to go much further, which is why we backed the package of recommendations from the CSPL as the first step in our plan to clean up politics. We want to see full independence granted to the adviser to open his or her investigations—without that, it is left to the whim of the Prime Minister. As I said, the Prime Minister cherry-picked the CSPL recommendations and conveniently chose not to introduce this crucial one. While he maintains the power of veto over the independent adviser, there is an inherent risk that he will overrule his own adviser. Today, it is time to show the Prime Minister that he is not above the rules and for this House to draw a line in the sand. If the Prime Minister will not appoint an ethics adviser, we must do so. I commend this motion to the House.

Michael Ellis: I thank the right hon. Member for Ashton-under-Lyne (Angela Rayner) for choosing today’s motion. It is a great pleasure, as always, to appear on the other side of the House from her, and I will endorse the opportunity she gave to call her a friend likewise.
The Government remain steadfast in their absolute commitment to upholding standards in public life and the critical role of the ministerial code in supporting those standards. It is on account of that commitment that the Government cannot support today’s motion, for the simple reason that it attempts, by proxy, to change the British constitution by the back door; what it does, without consultation or consideration, would be unreasonable. What would be unreasonable is for any Opposition party to say all this on what is, as they know, a national strike day, when many Members are hindered from attending this House, because Labour Members are on the picket lines for a strike caused by Labour’s union backers.
I have set out repeatedly and exhaustively in recent weeks that the Government fully recognise the importance of the ministerial code and its role in maintaining standards in public life. What we wish to do, therefore, is to protect the code. It sets out the Prime Minister’s expectations of his or her Ministers, detailing the standards of conduct in public life expected of those who serve government and the principles that underpin them. The code has performed this role for successive Prime Ministers since it was first published by the Conservative Prime Minister John Major as “Questions of Procedure for Ministers” in 1992, 30 years ago. Throughout that time, it has been an evolving document. It is customarily issued—it is customarily released or re-released—when  warranted, by the Prime Minister of the day to reflect changes and to update the guidance. So this business about what is said in the foreword of the document is, frankly, a red herring. What is said in the foreword is very often a reflection of the current affairs at the time the document was released. What it is not is a reflection of the contents of the document, which are as they were before.
Since 2006, recognising the need for independent support on the application of the code, the Prime Minister of the day has appointed an Independent Adviser on Ministers’ Interests to provide independent advice on how Ministers manage their interests and to assist with the investigation of alleged breaches of the code. But if Labour’s motion were to succeed, it could mean in the future a Labour-chaired Committee choosing one of the Prime Minister’s advisers or a Conservative-chaired Committee choosing a future Labour Prime Minister’s advisers. That would lead to dysfunction and, frankly, gridlock, and it would be entirely impractical and unconstitutional. It simply would not work.

David Linden: The right hon. and learned Gentleman spoke about the fact that the code was designed under John Major in the 1990s, although John Major’s Government were not exactly without scandal and sleaze, so perhaps it is time to revisit that. Given his knowledge of history, can he think of any Prime Minister who has lost not one but two advisers on the ministerial code since the days of John Major?

Michael Ellis: There are exceptions in every case and, of course, we know that in the past 30 years Prime Ministers of all political parties have decided for themselves when Ministers have their confidence and when they do not. The Government are very grateful to all those who have served in the role of independent adviser since 2006. It is a challenging role, and increasingly so today. Let me repeat my particular thanks to Lord Geidt for his contribution to the office, but the Prime Minister has also made it clear that the resignation of Lord Geidt and the issues that he and PACAC raised last week demand a moment of reflection. They demand some consideration. Frankly, we think it is right to step back and take some time to consider what we have heard from the former independent adviser and from this House. This is a complex matter and one that touches on Executive functions and the royal prerogative in relation to the appointment of Ministers. As I have said before to this honourable House, we cannot have a situation where we expect any Prime Minister of any political party not to have confidence in a Minister that he or she has serving in their Cabinet. It is crucial that each Minister has the confidence of the serving Prime Minister.

Sarah Owen: The Paymaster General talks about exceptional times, but unfortunately this is not exceptional behaviour from this Prime Minister. This is not the first time that we have heard allegations that the Prime Minister has sought to spend hundreds of thousands of pounds of taxpayers’ money on his girlfriends. Just look at his time as Mayor of London. Does the Paymaster General not agree that this is a pattern of behaviour and the role of any new ethics adviser should be, for a start, to get the Prime Minister out of the gutter and find some ethics in the first place?

Michael Ellis: I am not going to dignify that with a response.

Geraint Davies: The Minister mentioned that the ministerial code and the guidance change with the times, but is it reasonable to delete references to integrity, objectivity, accountability, transparency, honesty and public interest? Obviously, these are enduring values and they cannot just be airbrushed out by a PM who chooses to break all the rules for his own self-interest.

Michael Ellis: I respectfully advise the hon. Gentleman to read the document he is quoting. First, those lines were only included in the foreword of the document since August 2019. They are still within the body of the document. What it says in the foreword is very often topical and should not be taken as inclusive of every item that follows in the substantive document.

Robert Buckland: Further to that, are not the Nolan principles set out in annex A to the ministerial code? All this nonsense about their removal is factually wrong. However, will my right hon. and learned Friend commit today to do the process of the appointment of a successor to Lord Geidt as soon as reasonably practicable?

Michael Ellis: My right hon. and learned Friend is absolutely right about the code. I think it is annex A, and it may even be 1(c), although I may be wrong. The foreword is a topical document and how and by whom Lord Geidt is replaced are being worked through in detail.
The Government have only very recently made a number of significant changes to the remit of the independent adviser and to the ministerial code, and those changes were made in response to recommendations from the Committee on Standards in Public Life, as the former Attorney General, my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright), mentioned only a few moments ago. They represented the most substantial strengthening of the independent adviser’s role and office during the lifetime of that post. The role has been strengthened and increased substantially. I will not run through all the details of those changes again. In the light of last week’s events, it strikes us as reasonable to not rush in, but pause and reflect on how to do it properly.

Alistair Carmichael: If the changes that the Government recently brought forward are so significant and substantial, why do they feel it is necessary to have a pause for reflection again now, so soon?

Michael Ellis: Those are two different things, as the right hon. Member knows. We are talking about strengthening the role of the independent adviser, on which we had time to reflect and which we then did.
In no way do I suggest that the Government do not regard the role with the utmost importance; we do. In no way do I suggest that something of this importance will be left unaddressed; it will not. All I suggest is that we take a period of time to assess how best to perform that function. I appreciate that the motion allows a limited period of time, as it does not take effect until the independent adviser role has been unfilled for two months, but that timing presents two issues.
First, two months, with a deadline of 14 August, is simply an unduly short period to recruit for a role of such significance and sensitivity. Secondly, the motion allows for no time to think about how the role is delivered.  By proposing the creation of a sort of shadow adviser on Ministers’ interests, the motion simply demands the same model again without consideration of any alternative options. It also unwisely, if I may say so, innovates to expand the remit of an existing Committee without considering the impact that that will have on the operation of the ministerial code. As I said, the Government think that the time is right to reflect on this matter more carefully.

Alistair Carmichael: Will the Minister give way?

Michael Ellis: In a moment; I will just make some progress.
Let me move on to the detail of the motion, which is constitutionally rather important. It is predicated on a misplaced worry about the Government’s intentions, and that anxiety has created a jumble of misguided ideas. First, the creation of the new specialist adviser position stands directly at odds with the principle of separation of powers and the necessary distinction between Members and Ministers of the Crown. It would be an extraordinary shift of power from the Executive to the legislature, which would upset the long-established balance in that aspect of the United Kingdom’s constitution. It would be a reckless change that has not been thought through.
Her Majesty’s Government would not dream of appointing advisers to this House—that is for the House to do, and Mr Speaker would rightly protect the legislature’s independence—but the Opposition want the legislature to interfere with the independence of the Executive by appointing one of its own advisers. Effectively, that is a recipe for gridlock and confusion.
It is a fundamental constitutional principle that the Prime Minister of the day, as head of Her Majesty’s Government and the sovereign’s principal adviser, has sole responsibility for the overall organisation of the Executive and for recommending the appointment of Ministers. The Prime Minister, not Parliament, advises Her Majesty on the appointment of her Ministers. In turn, the Government of the day are accountable to the Commons and must command its confidence. That is our system. The ultimate responsibility for decisions on matters of ministerial conduct is therefore, quite properly, the Prime Minister’s alone, who draws his authority from the elected House of Commons. As an elected politician, those are matters for which he or she is accountable to Parliament and, ultimately, the electorate.
Flowing from those arrangements, the ministerial code is the Prime Minister’s document. It belongs to the Prime Minister and sets out the standards of behaviour that he expects from his Ministers. Likewise, the appointment of others to advise on the ministerial code is a matter for the Prime Minister. It would be similar to me appointing an adviser to the Leader of the Opposition, which would, of course, be absolute nonsense and would not be accepted by the Opposition.

Lloyd Russell-Moyle: As a member of PACAC, I would of course welcome being able to have further advice, but the Minister seems to have misinterpreted that issue. The motion proposes to appoint an adviser not to the Prime Minister, but to a Committee that can make independent judgments on the conduct of different areas of the Executive. The International Development Committee has an independent auditor who reports to it on the functions of the  Department. Other Committees have independent people who report to them on the functions of the Executive. There is no suggestion in the motion that it would be an adviser to the Prime Minister, or that it would take away from the Prime Minister’s responsibility to do the hiring and firing. The Minister has misread the motion, has he not?

Michael Ellis: The intent of the motion, as the hon. Gentleman well knows, is to stymie the Prime Minister’s power to have his own Ministers. [Interruption.] He knows full well that that is the intention behind this reckless motion, which seeks by proxy to turn those constitutional principles on their head, and would surely be a recipe for constitutional gridlock and confrontation. Hon. Members should perhaps consider for a moment what would happen under this new regime when the Prime Minister of the day disagrees with the parliamentary adviser. If the Prime Minister were to disagree with that adviser, he would be put under pressure to not have one of his own Ministers.

Andy Carter: I heard the point made by the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle). Could the Minister clarify that, if that Select Committee should wish to appoint an adviser, it does not need a motion of the House to do so?

Michael Ellis: Clearly, it is for that Select Committee to decide how it conducts its own affairs, but certainly as far as this motion is concerned, it would be unconstitutional. Rather than allowing the Executive to reflect on the role of the independent adviser, this motion is preoccupied—as I think the House knows—with immediate and short-term considerations seeking to capitalise on a current vacancy, which the Opposition are seeking to do for politically expedient reasons, without taking full account of the constitutional implications. The now repealed Fixed-term Parliaments Act 2011 is a prime example of what happens if one alters critical parts of the constitution without care.
According to the motion, referring back to what the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) said, it would be for the Public Administration and Constitutional Affairs Committee to appoint an individual to the new position of adviser on Ministers’ interests—not “adviser on the Committee’s interests”, but “adviser on Ministers’ interests”—and it would be for PACAC to refer matters that that Committee believes warrants consideration to its new adviser. With or without PACAC, that adviser would be able to instigate consideration of a matter, so the motion is an attempt to give the impression that powers have been transferred from the Executive to the legislature.
Given its novel character, perhaps it does not come as a surprise that the proposal stands in direct contradiction to the principle acknowledged in the code of conduct for MPs and the associated guide to the rules. That current document, which the House has approved, clearly states that
“Ministers are subject to…guidelines and requirements laid down by successive Prime Ministers in the Ministerial Code”.
The guide to the rules clearly recognises that those requirements
“are not enforced by the House of Commons”.
The Opposition are seeking to reverse that agreement by the House.
The challenge to constitutional norms is not confined to the operation of the Executive. The motion also proposes to change the way in which Parliament and its Committees conduct their work.

Jackie Doyle-Price: My right hon. and learned Friend is absolutely right when he quotes the code of conduct. However, without an ethics adviser to the Prime Minister, we as Members of this House are held to higher standards of behaviour through the code of conduct than Ministers are, including the Prime Minister. What can my right hon. and learned Friend tell us about how, going forward, the Prime Minister and the Government intend to ensure we can expect all Ministers to be held to the highest possible standards, just as we in this House are?

Michael Ellis: I can certainly say to my hon. Friend that those sorts of questions are being worked through now in detail.
As I said, the challenge to constitutional norms is not confined to the operation of the Executive. The motion specifies that
“the Adviser may advise the Public Administration and Constitutional Affairs Committee on the appropriate use of its powers to send for persons, papers and records”.
The power of Select Committees to send for persons, papers and records is delegated to Select Committees from Parliament itself, and exercised by Members of this House as directly elected representatives. Although Select Committees already have the ability to appoint specialist advisers, introducing a requirement to appoint an adviser whose remit includes advising the Committee on how to use its powers would be different, unusual and undesirable. Although Select Committees may wish to draw on the advice of experts from time to time, this expertise does not ordinarily extend to advising Committees on how to use their historical powers to gather evidence.

Geraint Davies: I am listening carefully to the right hon. and learned Gentleman’s argument, but does he accept we are in unusual territory? The conduct and behaviour of the Prime Minister himself have been called into question, supported by the evidence. It would therefore seem inappropriate for the Prime Minister to appoint his own ethical adviser. Given that we have an independent judiciary, does the right hon. and learned Gentleman not think we should investigate the possibility of an independent appointment through the judiciary to enforce ethical standards in our democracy?

Michael Ellis: I am in the business of protecting our judiciary from becoming politicised, which would be a danger with the hon. Gentleman’s suggestion.
Select Committees already have a vital role to play in scrutinising and holding the Executive to account, which is why the Standing Orders provide the power to send for persons, papers and records. The creation of this new position would not augment the powers held by Parliament and its Committees but would serve to undermine the fundamental principle of the separation of powers.
As I have outlined, the House has previously acknowledged that Ministers are necessarily subject to an additional set of standards over and above that of Members. Providing a role for Parliament to initiate investigations into potential breaches of the ministerial code would be constitutionally irregular and would pre-empt the review that is currently being undertaken.

Lloyd Russell-Moyle: Is it not the case that a number of Select Committees already conduct pre-appointment hearings for people directly appointed by the Prime Minister? Those Select Committees can already say whether they recommend or do not recommend appointment. The Prime Minister can go against a Committee’s recommendation if he wishes, but it will be on the public record. There will be a paper trail so everyone knows what has happened, and light and fresh air will be let in to abolish the darkness of corruption. Would this proposal not do that if it were implemented?

Michael Ellis: No.
The creation of an adviser with the power to initiate consideration of a potential breach of the ministerial code is different, and we can safely predict it would open the door to a wave of frivolous and vexatious complaints. We have to think about that and the reputation of this House because, now and across all future Administrations, there would be no downside in political opponents throwing in complaints like confetti. The Opposition of the day would not face tit-for-tat complaints, because they are not Ministers.
As we saw with the failed Standards Board for England in local government, a culture of petty complaint would undermine not strengthen confidence in democracy, which is precisely why such arrangements need to be thought through, to consider and avoid the unintended consequences that will ultimately afflict both sides of the House.

Robert Buckland: My right hon. and learned Friend is being generous in taking interventions. I agree about the importance of balance between the Executive and the legislature. May I press him on the need for a mechanism to appoint a successor to Lord Geidt? I understand that he cannot give us dates or commitments, but can I have an assurance that a successor will be appointed as soon as practicable?

Michael Ellis: What I can say to my right hon. and learned Friend is that the matter is being given very careful and full consideration. I hope that answers the point.

John Penrose: I am gravely concerned about what I have just heard. A number of us were given to understand, before the debate began, that the Government were willing to say that there is a strong commitment to finding a replacement for Lord Geidt in short order. I have not heard the Minister say that. Will he please make that very clear right now?

Michael Ellis: I do apologise if I have not made that clear; I thought that I had. I can confirm that that is the position.
Let me conclude by reassuring hon. Members that it is the Government’s intention to act swiftly. I emphasise that to hon. Friends around the House. We will act swiftly to undertake a review of the arrangements in place to support the ministerial code and ensure high ministerial standards. During that period, the process of managing ministerial interests will continue in line with the ministerial code, which sets out that the permanent secretary in each Department and the Cabinet Office can provide advice to Ministers and play a role in  scrutinising interests. The latest list of ministerial interests was published just two weeks ago, and the Government’s publication of transparency information will of course continue unaffected.

Joanna Cherry: I want to clarify what the Minister said in that last passage. His own Back Benchers seem very keen to establish on the record in Hansard that the Government have given them some sort of undertaking that they will act swiftly to appoint an adviser, but what the Minister said there was that he would act swiftly to institute a review. Which is it? Are the Government going to act swiftly to institute a review, or to appoint an adviser? I think that might affect how his Back Benchers vote this evening, so he needs to be clear.

Michael Ellis: It is very kind of the hon. and learned Lady to be interested in how the Back Benchers vote, but she ought to be concerned about her own party in that regard. The reality of the matter is that I have made my position perfectly clear: the position will be dealt with in good time. The how and when are being worked on—[Interruption.] I cannot be any clearer than that.

Simon Hoare: May I gently say to my right hon. and learned Friend that he will appreciate that, whether we like it or not, this issue of ethics is proving to be a bit of an Achilles’ heel with the Government. It is in the interests of the Government to have a replacement to Lord Geidt as quickly as possible. I have heard what he has said in response to a number of interventions, and so it may be me, but could he say once again for the record that an adviser in this important area of the mechanism of government will be appointed as swiftly as possible? A review of the terms of reference is ancillary.

Michael Ellis: Whether it be the phrase “as soon as reasonably practicable” or “as soon as possible” is somewhat immaterial, but I think I have made it clear. I am trying to emphasise that, while the how and when are to be worked out, the Government will work with every possible expedition.
On this motion, I would say it is in the Government’s interests and intentions to bring their review or the arrangements into play efficiently and in good time. As my hon. Friend says, it is in the Government’s interests, but it is also in the interests of the whole House, because the matter of ethics and standards is of relevance to all of us. Frankly, Labour’s high moral tone is perhaps not quite appropriate when its members find themselves under police investigation in Durham—

Angela Rayner: Your Prime Minister broke the law!

Michael Ellis: My friend intervenes from a sedentary position, but was she or was she not having an Indian meal in Durham? It is something of a korma, korma chameleon, one might say.

Karin Smyth: If we could return to the matter in hand, we are trying to establish whether the Government are swiftly moving to instigate a review, or swiftly moving to appoint. When Lord Geidt came before the Public Administration and Constitutional Affairs Committee in May 2021, he told us that his name had been “alighted on” by the Prime Minister. Can the Paymaster General  tell us whether the Prime Minister will be alighting on a new name, reviewing the alighting on of a name, or reviewing an open application process? Can he give us a little bit more about that?

Michael Ellis: The Prime Minister intends to appoint a new ethics adviser. We will announce how that is to be done, who it is and how it works in due course, but it has to be done properly to ensure that Parliament and the public have confidence. This motion pre-empts that review process and unnecessarily seeks to hold the Government to an entirely arbitrary timetable. We firmly believe that it is better to undertake this work with proper diligence and attention than to conclude it in haste, without proper consideration of the issues raised by Lord Geidt and the Public Administration and Constitutional Affairs Committee. It is for those reasons that the Government would oppose the motion.

David Linden: The Minister’s repeated reference to “in due course” has piqued the interest of those of us familiar with the work of Sir Humphrey Appleby. Will he go a little further and define what “in due course” means? For example, would it be before the conference recess, or the summer recess? [Interruption.] Maybe his Parliamentary Private Secretary is telling him right now.

Michael Ellis: I think that the hon. Member knows what “in due course” means, and, if he does not, he will have to work it out.
Labour chose this debate on a day when the Labour rail strike is in progress. It is utilising its valuable time in the Commons not to discuss policy—Labour Members do not discuss policy because when they do, they lose—as it would rather talk about personality, and I am surprised that it chose this debate at this time when half of its Members are apparently on the picket lines.

Pete Wishart: Well, there we have it, in the Minister’s own words, as clear as he could possibly be: it is abundantly clear that the Government have absolutely no intention whatsoever of moving speedily to replace their ethics adviser. If all the crowd on the Conservative Back Benches are prepared to be taken in by that rubbish, God help them when they have to try to consider some of the important issues of today.
We have heard from the Minister that there will be a review into the arrangements about the appointment of an ethics adviser. Why could he not have come to the Dispatch Box to state exactly and clearly what he intends to do, instead of mucking around with all of that rubbish and nonsense, skipping through God knows how many hoops and dancing on the head of so many pins? That would have been more useful to the House. We have had to listen to something like half an hour of unmitigated rubbish, and now we know that they will do nothing other than create some sort of review about how they will take the matter forward.
I do not know where to start when it comes to considering the ethics of this Prime Minister and Government. This is a Prime Minister with the ethics of Caligula and a Government with the morals of the last days of the Borgias. How the Prime Minister is still in place after all of this must go down in the history books as one of the great mysteries of early 21st-century politics. When the book is written and that feature film  is eventually released, people will ask, “Did all of that seriously happen? Surely this must be a fictional account of this particular Conservative Government?”
There has never been a Prime Minister quite like it. He is a weird combination of privilege, narcissism, nastiness and naivety all wrapped up under the bumbling facade that he has carefully concocted to make his multitude of sins evaporate in front of our faces. He is about the worst Prime Minister to be in place at the worst possible time. No one has been more ill-equipped to run a community council, far less the Government of an advanced developed nation and democracy in western Europe. If there is one Prime Minister who is in need of ethical advice and the assistance of a moral compass, it is surely this Prime Minister. Far from doing away with the post—that plan is abundantly clear—the Government should be spending half of the UK’s GDP on creating an army of ethical advisers just to get on top of what is going on in the Government.
I have to say that, like the Culture Secretary, I was a little bit surprised to find out that we actually had an ethics adviser. I would not be surprised at all if the Prime Minister had an adviser for hedonism and partying hard, but ethics? He must be keeping his several successes in the course of the past few years hidden beneath a particularly big bushel. I do not know if he was a bit distracted when the Government were breaking the laws that they themselves created, distracted when they were threatening to break international law, distracted when they oversaw a culture at No. 10 that partied so hard that people were physically sick, got into fights and then abused the staff who were there to clean up, or distracted when the Government attempted to prorogue Parliament unlawfully and who continue to put their own cronies and donors in the House of Lords. But I suppose it gets to the stage where enough is enough even for the most patient, distracted and forgiving adviser, and the recognition finally dawns that this is an impossible task beyond the realms of human wit.
It comes as absolutely no surprise that the Government feel they can function quite adequately without an ethics adviser in place. They have been through two in the course of the past few years. Neither felt that they could make any real difference to the ethics and behaviour of this Prime Minister. That leads me to ask: what would an effective ethics adviser to this Prime Minister actually look like? They would need the ability to turn a blind eye and stomach some of the worst possible behaviour at the worst possible time. They must be able to take the abuse and disparaging comments from some of the Prime Minister’s friends, such as the Culture Secretary who, in her usual measured and respectful way, calls the current Lord Geidt “Lord Geddit” and says that voters do not care what he was or what he did. As part of the recruitment drive for the next ethics adviser, the Culture Secretary encouraged potential applicants for the post by saying that the public “don’t give a fig” about the job. Now, watch the great and good run forward to try to claim that particular prize.

James Wild: The hon. Gentleman is making a typically measured speech himself. In talking about ethics and standards, can he confirm whether the SNP Westminster group still has a zero-tolerance approach to sexual harassment and inappropriate behaviour? A leaked recording this weekend would indicate that that is no longer the case.

Pete Wishart: Obviously, I am not going to discuss any sort of leaked information that has been passed on to the press. What I will say to the hon. Gentleman is that if he is sitting in a glass house with a big rock, it is probably best not to throw it in any direction. I remind him that I was on the Independent Complaints and Grievance Scheme and put together the report that is now in place; one of the most successful initiatives we have had to tackle abuse in this place. I will take great pride in the fact that that was part of the arrangements concerning that.
I will finish with the Culture Secretary. Once she has finished her tenure in the Department for Digital, Culture, Media and Sport, which hopefully will be short-lived, she could maybe go on to become an international diplomat or peacemaker, given her ability to say the right things at the right time on issues that require sensitivity and care, just as she has in the last few weeks.
In an attempt to save face and further discredit Lord Geidt—this is perhaps one of the most concerning pieces of spin from the past few days—the Government were able to develop a narrative that his resignation was nothing to do with the appalling behaviour of the Prime Minister but a misunderstanding about steel. Because of the Government’s remarks and the spin from the Government’s friends in the newspapers, Lord Geidt felt it necessary to write a second letter to clarify exactly why he resigned. He said that it was nothing to do with steel, and that steel was an absolute and utter distraction. He said it was instead about being asked to approve deliberate breaches of international law given the Government’s
“widely publicised openness to this”.

Joanna Cherry: The Minister seemed very reluctant to confirm that a new adviser will be appointed anytime soon. Does my hon. Friend think that that is probably because the Government have it in mind to breach several international treaties in the coming months and it would be very awkward for them to have an adviser in place who would be advising them against that or possibly resigning because of their plans to do so?

Pete Wishart: My hon. and learned Friend is coming to the right conclusions about the Government’s indecision and apparently clear intention of not having an ethics adviser put in place at the earliest possible opportunity. A number of things are coming up—I will mention a couple of them—in the in-tray for any adviser to consider, some of which will greatly concern Members of this House.

Jamie Stone: I wonder whether the hon. Gentleman would agree that further delay and dilly-dallying in the appointment of an ethics adviser does nothing whatever to restore public confidence in our Government?

Pete Wishart: The hon. Gentleman is absolutely and utterly right. I do not think that, in my 20-odd years in the House, I have seen it in such a dilapidated condition, when public trust in the activities of the House, the way in which we do business and the way in which we conduct ourselves has been so badly misunderstood and misinterpreted by the public. It is incumbent on the House to start to try and put these things right.
Let us get back to our good friend Lord Geidt. I do not know what it was in his comments that he had been left in
“an impossible and odious position”
and that he could not be
“party to advising on any potential law-breaking”
that led to any misunderstanding about his intention to resign from his role, and the real reasons why he eventually got around to it. Perhaps he had to be got rid of because it was he who had previously investigated the controversy over how the Prime Minister had funded the refurbishment of the flat above No. 11 Downing Street.
My hon. and learned Friend the Member for Edinburgh South West (Joanna Cherry) referred to several issues that might require the attention of a future independent ethics adviser, but surely the one at the top of his inbox would be our emerging concern that the Prime Minister was seriously considering appointing his now wife to the role of special adviser in the Foreign Office. That is a matter that I think the House will have to return to in due course, and consider properly. Although Lord Geidt concluded that the Prime Minister had not broken ministerial rules in respect of the prime ministerial flat, the Conservative Party was later fined £17,800 for the improper declaration of donations.
So Lord Geidt is gone, and I have the impression that Downing Street is not particularly upset about that, but what is to be done? I have no problem with the Labour party’s motion, and I will support it; the only thing that I would say to Labour Members is that I would not give them the chance to try and find an independent adviser on the Government’s ethics. In any event, I think that it should be a matter for the House. I accept that some of these issues are relevant and pertinent to Government activity and business, but surely the House should have some sort of say, through the function of its Committees, in who does the monitoring and how that person is appointed. The present system has not worked particularly well in the case of the last few independent advisers. I think that we would need to find someone with the attributes of Gandhi, Mother Theresa, Columbo and George Washington combined to perform this role effectively.
In Scotland, of course, we have our much neater and easier way out of this midden, and that is to simply leave all of you to get on with it in your own time and in your own way. I have no idea what Scotland has done in its history to deserve governance such as this, but believe me, Madam Deputy Speaker, my colleagues and I are doing everything possible to ensure that the situation will be rectified. When it is right that we put forward the case for independence—as we will, and we will convince the Scottish people of its merits—all we need to do is to get the Scottish people to turn on the Parliament channel and observe what is happening in the House. That will increase their enthusiasm, and cause them to rush towards the cause of independence. The choice for them will be whether to be governed by these privileged Etonian spivs with their “one rule for them” approach to government, or to become a self-governing nation run by the people who care most about Scotland—the people who live and work there.

William Wragg: It is a pleasure to be called to speak in the debate.
The motion in the name of the Leader of the Opposition is deeply flattering to me—presumably—and to the Committee that I have the great pleasure of chairing. I appreciate the Opposition’s confidence in us, but would gently encourage them to have more confidence in themselves rather than deferring entirely to my Committee.
In the exposition with which he responded to the deputy Leader of the Opposition, my right hon. and learned Friend the Paymaster General remarked that the motion was unconstitutional, and I have to say that perhaps it is. However, I increasingly find that the Government themselves advance all sorts of propositions that could be described as unconstitutional in the first place, not least the assertion by some members of the Cabinet that we now have a quasi-presidential system of government. That, I imagine, would be news to Her Majesty. I might ask whether the reading of choice in the Cabinet is indeed Dicey and Bagehot nowadays, or perhaps something a little lighter.
The Public Administration and Constitutional Affairs Committee has not requested these powers, but I understand the sentiment behind them. It is the imperative to appoint a new adviser to the Prime Minister on ministerial interests, which, if I am to decipher what my right hon. and learned Friend said earlier, is something that they are keen to do.
I will, if I may, briefly reflect on what happened last week. Lord Geidt appeared before the Committee on Tuesday. He went through an astonishing transformation, it seems, over the course of that week—those who may have been a little critical of his appearance on Tuesday were regarding him as a great national folk hero by Wednesday. I am sure that he was touched by that change of heart. None the less, he certainly had a difficult time, not on the basis of him as an individual—a man of flawless reputation, I might advance, with a distinguished record of public service not least to Her Majesty—but probably because he was defending a sticky wicket. He found the need to bring clarification to the motivation behind his resignation in a letter to me on Friday. It is clear that Lord Geidt is not a political creature, but that is exactly the kind of quality that is needed in the independent adviser.
It should not go without challenge in this House when Ministers appear in the media, but some unhelpful perceptions have been created. I am afraid to say that the Secretary of State for Digital, Culture, Media and Sport was wheeled out on the radio on Friday—presumably for the nation’s entertainment rather than its edification. Her appearance was quite astonishing. I agree with her on one thing though. Let me paraphrase what she said. “Never heard of him”, she said. That is quite right. I do not think that the independent adviser to the Prime Minister on ministerial interests should be heard of, because the sort of the work that they undertake should be done thoroughly, but discreetly. It should never capture the public imagination—I think that that is more of a reflection of the times in which we are living, which, largely, are of our own making.
I would further question why my right hon. Friend, the Secretary of State for Digital, Culture, Media and Sport, felt the need to observe that Lord Geidt had been complaining about the amount of work that he had to do. Well, we know what could be done about that perhaps. All I would say in praise of my right hon. and learned Friend on the Treasury Bench is that he is a  complete contrast to the Secretary of State for Digital, Culture, Media and Sport, and I welcome his sensible and considered approach to these matters and indeed the emphasis that he placed in, I think, the urgent question last week, which was that it was vitally important to have such a position filled.
On the question of whether people care, I think that, yes, they do care. The British public are, on the whole, capable of having two thoughts in their minds at once. Yes, they are able—by their own painful experience quite often—to understand the cost of living crisis. Yes, they are entirely able to have empathy and grave concern about the situation in Ukraine, but they are also able to judge the Government on whether they think that they behave—not perfectly, because that is not what people expect—with at least an adequate degree of propriety. I say to colleagues that we might gently remember the Standards Committee report from the autumn, which I thought would have shown that, for many, this was an area of interest that the public thoroughly understood.
I shall conclude briefly, the House will be relieved to know, as this matter does not really need a great deal more from me. Why do we have an independent adviser? It comes from a 2006 recommendation from the Committee on Standards in Public Life. There are practical reasons why these advisers are necessary. It is that they can give objective advice to the Prime Minister of the day. In fairness to the Prime Minister of the day, or the Prime Minister at any time, they have a difficult role in forming a judgment on close colleagues and, indeed, even friends. They need to be able to draw upon and be able to back up their decision with that advice.
I completely support the idea that the Prime Minister has ownership of the “Ministerial Code”. It is his code, and it is right that it should be so. We should not be upsetting that constitutional principle. However, we need to make sure that there is an adviser, with the Prime Minister as final arbiter, in a way that allows for that transparency in the difficult decisions that they make.
So, although personally deeply touched by the Opposition’s confidence in me, and indeed in the illustrious members of my Committee, I am afraid that I will not actively support their motion, which I know will upset them dearly. But as the right hon. Member for Ashton-under-Lyne (Angela Rayner) and I go back an awfully long way, to the time when she was union representative at Stockport Council and I was a mere humble councillor for the Hazel Grove ward, I trust that she will take what I have said in the spirit that it is intended. I look forward to hearing the rest of the debate.

Karin Smyth: It is a pleasure to follow the hon. Member for Hazel Grove (Mr Wragg), the Chair of the Public Administration and Constitutional Affairs Committee, of which I am one of the so-called illustrious members and very pleased to be a part.
Only two weeks ago, I spoke in another debate about the importance of standards in political life and how important they are to my constituents. At that time, the Government were trying to move us on, and that has not worked terribly well, but the issues that we are talking about today are important and do matter to our constituents. I said then, as a member of the Committee, that not many members of the public knew about our  work—the long hours of deliberation, reports and inquiries, and how we had a certain Lord Geidt coming before us shortly. I ended up by saying that because of how our constitution now works and how the Government have behaved, all roads lead back to the chap at the top of the structure. The culture emanates from there, including the non-attendance before Select Committees, the late publication of documents, and the many other examples that were outlined in that debate—so here we are again.
As well as reviewing the evidence that Lord Geidt gave to the Committee last week, it is worth reviewing his post-appointment hearing evidence taken on Thursday 13 May 2021, his name at that point having been alighted on by the Prime Minister following the resignation of his predecessor. In that session, we explored the lessons from Sir Alex Allan’s resignation and the issue of independence and advice. In response to questioning led by my colleague and friend, in this regard, the hon. Member for Thurrock (Jackie Doyle-Price)—she is in her place—who asked about recognising that we all have a view on and understand what is good and bad behaviour and what is constitutionally appropriate, Lord Geidt said:
“As I have heard other people say recently, good behaviour is a very difficult thing to legislate for. I join those who suggest that it really needs leaders—of course, the Prime Minister, Parliament and civil servants—to set the necessary example. I hope very much that the work that I do in this role, which is described as “adviser”, will be in the service of advising the office of Prime Minister in the furtherance of that behaviour, taking the Ministerial Code as its point of reference. I agree with you that rules are absolutely not sufficient to stimulate good behaviour.”
We fast-forward to earlier this year and the warnings that Lord Geidt was then moved to give, in the strongest terms he possibly could, in the introduction to his annual report. Before our session last week, on 14 June, I was not sure which Lord Geidt would be before us. Were we to get the one who appeared before us in May 2021, believing, as a chap of the system, I think it would be fair to say, that the system had worked, that his predecessor’s resignation showed that it worked, that updates to his terms of reference gave the independence that was necessary, and that leaders, crucially from the top, set the necessary example; or were we to get the one who was the author of the annual report? Following a fairly intense session of questioning on a number of different issues in the inquiry, we clearly found out just the very next day which Lord Geidt we now had.
Our post-appointment session in May 2021 focused on the issue of wallpaper. Our last session was about a number of things, including the legal advice on the breaking of international agreements. That really is quite a leap, isn’t it, in only a year? I asked particularly about the leaking of legal advice on the breaking of the Northern Ireland protocol. We know that that advice has been leaked. We know that it is a serious breach of the code. We know that this has a profound impact on the UK’s constitution and domestic politics as well as on our international standing. We know that the legal advice is disputed. We know that the doctrine of necessity is extreme. We heard again this morning from experts on international law quite how unusual the new doctrine of necessity that we now have in the protocol is.
In a series of questions, which I am going to refer to, I asked Lord Geidt about where this advice had been leaked from—essentially, whether it was from the Prime Minister or from the Attorney General. I asked him whether he had been asked to investigate that situation. I said that
“we do have a recent leak with regard to the legal advice on the Northern Ireland protocol”,
and asked him whether that constituted “a relevant example” for him to investigate. Lord Geidt said:
“It may well do. You will recall that my new powers are squeaky new and I have not either been asked to or, indeed, pressed my own interest in giving advice in that example.”
I asked Lord Geidt if the Prime Minister
“has not asked you to investigate why that legal advice was leaked”.
Lord Geidt said, “No, he had not.” I asked if the Attorney General was asked how the advice had been leaked? He asked me, “Have I asked?” I said yes, and he said, “No, I have not.” I said:
“But your new powers do allow you to ask”
the Attorney General. Lord Geidt responded:
“I think that my new powers would allow me, unrestricted, to ask questions of the entirety of Government and others.”
I said:
“You raised the issue of the leak”—
he had done that earlier—
“The leak is clearly very serious… I would suggest it breaches the ministerial code, point 2.13. Would you agree?”
Lord Geidt said:
“I have not formed any advice and I have not brought an inquiry to bear on the situation.”
I then asked if he thought it breached the ministerial code. He said:
“Again, I would want to ensure that I could consider that fully before reaching a determination. By the way, as you know, the determination is then only advice to the Prime Minister.”
I asked:
“Have you looked at reaching a determination before?”
and he said, “In this case, no.” We would seem to have been going round in circles.
Part of that emanated from some correspondence from the shadow Attorney General, my right hon. Friend the Member for Islington South and Finsbury (Emily Thornberry). She had written to Lord Geidt to ask for advice, and he said he had responded to her, but that had not been received at the time. She has now received an answer, and again we are somewhat going round in circles. Lord Geidt responded to her finally, saying: “In the event of an allegation of unauthorised disclosure of information by persons unknown, it is open to the Government to commission an internal leak investigation where the Government in the circumstances considers it is appropriate, but that would be a matter for the Government to take forward and would not, at least in the first instance, be a matter for the independent adviser.”
We are left on a circuitous route of trying to understand where a very serious leak has occurred. It is a clear breach of the ministerial code that seems to be no one’s job to investigate or move forward. That is simply one example of the very many outstanding breaches of the code now lurking behind the doors of Downing Street. Where do we now go? Ideally, we would like to return to  decency in politics. This motion provides an interim solution. As I said when I intervened earlier, it is up to other hon. Members in this place to come forward with other solutions if they do not think this solution is suitable. The Government are being given a window, should they wish to take it, to do something decent.
Our Committee, as the Chair has outlined, has a long list of current inquiries and a future work programme. We are not particularly looking for extra work, and this is clearly a matter for the Government under our constitution. However, I know that Parliament takes this seriously, and Parliament can and will step up. We will find a way through this to bring decency back into our politics. Again, at the end of these very long days, our commitment is essentially to our constituents. This is being taken seriously by a number of Members of the once great Conservative party. Our commitment remains on the Opposition Benches, and we will continue to pursue bringing back good standards of government, despite what the Prime Minister wishes to happen.

Alberto Costa: At the outset, I should like to remind the House that I am a member of the Committee on Standards and of the Committee of Privileges. Accordingly, I will keep my comments short and away from any specific incident or series of incidents, or any particular personalities involved or alleged to have been involved, in any particular case or cases. My comments this afternoon relate to our constitutional arrangements and why I am unable to support the Opposition’s motion.
I have long championed enhanced standards in this place. I have been instrumental in putting forward proposals to develop our standards processes, and ensure that both complainants and those complained of are given a fair, transparent hearing, with a good appellate system. But I think the comments of my right hon. and learned Friend the Minister for the Cabinet Office and Paymaster General should be carefully listened to by all Members of the House. He rightly referred to the separation of powers, an issue that I regularly raise on the Committees on which I serve. It is useful for the House to remind ourselves of what we mean by “separation of powers”. It may be trite of me to do this, but some Members have come to me stating that they do not believe that the UK has any separation of powers, so it is important to remind the House of what we mean by separation of powers.
There are, of course, three arms to the British state—three organs of the state: this place, with the House of Lords and the sovereign in Parliament, which is the legislature, whose principal role is to make law; the judiciary, which comprises the courts and tribunals across the whole of the UK, whose principal function is to enforce the law that we make; and the Executive, who are of course a creature of this legislature, but are separate from it. They are separate from it and have their own staff, whom we call civil servants. Civil servants are loyal to the Government of the day and act impartially, but they are not neutral; they are there to further the democratic and legitimate aims of the elected Government of the day.
Part of our democratic and constitutional arrangements is that the Prime Minister of this country, the Head of Government of this country, has very limited defined powers, but one of them is patronage: choosing his or  her Cabinet, choosing those who serve the Government. That includes choosing those who are operationally independent of government but part of the Government. That includes a very large number of people. This place also appoints individuals who are called “operationally independent” of the House, but who are officers of the House. Given that we are having a discussion on standards, let me say that the most obvious office holder who is a creature of the House of Commons—the office is created by this body—is of course the Parliamentary Commissioner for Standards. Notably, the other House of the British legislature has its own Commissioners for Standards, separate from the officer of this House.
So it is imperative that in order to consider how Members might vote on this motion, we clearly understand the delineations of the separations of power. That is why the comments made by the able Minister at the Dispatch Box were absolutely correct; it would be utterly irresponsible to pass a motion that would create confusion and create the very opposite of what we want to see, which is transparency. What would happen is that the legislature would, in effect, be given authority over another arm of the state. We would not dream of appointing a House of Commons adviser on standards to the judiciary, would we? Would we impose our standards on day-to-day operations of the judiciary? That would be absurd. In fact, it would be dangerous.

Jackie Doyle-Price: I share in some of what my hon. Friend is saying, but we are talking about Ministers who are both simultaneously Members of this House and members of the Government. The fact remains that Back-Bench Members of Parliament are subject to more scrutiny through the Parliamentary Commissioner for Standards than we have in the current situation with Ministers responsible to the Prime Minister through the ministerial code, unless there is some transparency through a process through an ethics adviser. Will my hon. Friend comment on that?

Alberto Costa: I welcome my hon. Friend’s intervention because it allows me to clarify what I consider to be an error. The right hon. Member for Ashton-under-Lyne (Angela Rayner) said that we must have a system of conduct that affects each and every one of us, but we do: all members of the Government are Members of this House or of the other place, and they must abide by a code of conduct. That code of conduct is adjudicated on by the Parliamentary Commissioner for Standards in this place and the commissioners for standards in the other place, as well as the respective Committees on standards.
Most importantly, I should add that, under our system, the de facto sovereign body—the supreme governing body—of our country is this place, ultimately, Ministers are accountable to all hon. Members when they are at the Dispatch Box, and so is the head of Government. Under our constitution, if the head of Government loses the confidence of this House, they lose the role. That is the ultimate conduct check that our system allows for. Any moves to change that system, whatever the intentions might be—they might be noble—ought to be properly debated and consulted on, and must be cross-party in approach. It would be highly irresponsible to force through such a motion, which seeks to fundamentally alter our British constitutional arrangements vis-à-vis the Executive.

David Linden: I would contend that the motion is more an issue of House business than necessarily of the constitution, but we may disagree on that. I want to go back to what the hon. Gentleman said about this place not interfering with the judicial system. Is it not the case that many Conservative Back Benchers, although perhaps not him, would be quite happy to see, for example, the Supreme Court taken out of the equation because it has become unnecessary, unyielding and not helpful to the Government? Are the Government not guilty of trying to interfere with the judicial system?

Alberto Costa: I understand why the hon. Gentleman makes that point, but the counter-argument to that is that this is the locus and the forum for having thorough debates. When the Government of the day make proposals in respect of our legal system—of course the Scottish Government and the Scottish Parliament are wholly in control of the Scottish legal system, which is another great legal system of the United Kingdom—our respective Parliaments are the arenas to discuss, debate, vote on, challenge and scrutinise them. This motion and this short debate do not begin to scratch the surface of the scrutiny required in those sorts of debates, so hon. Members who are thinking about voting for this motion ought to ask themselves whether this short debate is justifiable in terms of length and scrutiny before making such a change.
I re-emphasise the Minister’s point about the accountability of the individual appointed. At present, as I said, the Parliamentary Commissioner for Standards is an officer of this House and is not accountable to the other place or to the Government; she is accountable to us—this House of Commons. It is wholly unclear in the motion whether, in appointing an adviser, that adviser would hold the same authority as an officer of this House. Would that individual also acquire the right to conduct investigations under parliamentary privilege? Would they have the power to command any witness to appear before them and demand the disclosure of evidence? Exactly what is meant by an “adviser to the Committee”?
PACAC is a distinguished Committee, and it has a distinguished Chair in my hon. Friend the Member for Hazel Grove (Mr Wragg), but exactly what sort of powers does the motion suggest should be given to that putative standards commissioner? That is what I think the motion entails: it creates another standards commissioner.

John Penrose: Does my hon. Friend agree that one worrying thing about the motion is that there is no end date to the adviser’s position, once established? Were the adviser to be in place and then the Prime Minister were to appoint his or her own adviser, we would have two different advisers, one advising the Committee and one advising the Prime Minister, potentially arriving at different conclusions from the same facts.

Alberto Costa: Indeed, and of course that emphasises the political motivation behind the motion, which is to create mischief and the very opposite of transparency. It would just create the opportunity to castigate the Executive of the day. I say gently to the Opposition that what is sauce for the goose is sauce for the gander. We have a mature democracy in our country, and whoever wins at election time—whichever party holds a majority in this House—becomes the Government immediately.  There is no transition period. With this motion we would be seeking to fetter that Executive, and particularly the Head of Government, preventing them from undertaking their important constitutional duties.
For those reasons, and many more that would come out if we had a proper debate on the motion and proper scrutiny of it, I believe that it is deeply misguided. I encourage all Members to put aside party politics and vote it down.

Lloyd Russell-Moyle: We have heard a good discussion today and a good speech by the hon. Member for South Leicestershire (Alberto Costa), although I do worry that he was dancing on the head of a pin in some of his constitutional reflections.
It is as simple as this: the public have lost trust in the Prime Minister, and 140-plus of his own Members of Parliament have lost trust in him on these matters. Add that to the number of Opposition Members, and a majority of Members do not trust him. This House therefore has a duty to act. That is the constitutional reality, and all the other academic waffle is for the birds. What is important is good behaviour—the system relies on that. The Prime Minister has not behaved as well as he should have done, and his colleagues know that.
It might well be that some actions are excusable, and that they are not all sackable—I mean breaches of the ministerial code rather than the Prime Minister’s behaviour —and that is why we need a fair and just system to make that determination. At the moment, the danger is that the public just damn us for everything. Small, vexatious issues are brought up about a Member delaying the registration of an interest here or there, and of course those administrative matters require slaps on the wrist, but they are not resigning issues. The public conflate those issues with serious misbehaviour, whether it be corruption such as trying to appoint friends or family, law breaking or sexual assault.
This place realised that marking our own homework on sexual assault was not good enough—the public will not accept that, however much we dance on the head of a pin about it as a constitutional issue. We therefore had to come up with a hybrid system. Members could have an input and act as a reality check, but the independence of the system had to be guaranteed, complaints had to be investigated and outcomes had to be public. That is what we need in this situation. More importantly, we need a commitment that independent advisers will be appointed and listened to.
The fact Lord Geidt had to clarify his resignation letter because the Government manipulated his words to try to condemn him for resigning over steel tariffs, which he said was not the case, shows the depths to which this Government will go. In that clarification letter, he agreed that
“When the Prime Minister is asking his own adviser to advise on the Prime Minister’s conduct it really doesn’t work.”
How do we, as a Parliament and as the people who fundamentally decide on the Prime Minister’s conduct, get our advice? How do we get the information we need, bearing in mind that the Prime Minister’s consideration is behind closed doors? We know about this only because Lord Geidt felt he had to resign.
The motion is probably imperfectly worded, and it could probably be improved and tweaked. Our constitution is evolving, and it can always be improved and tweaked. Not only should the Prime Minister have an adviser—I would welcome it if he appointed one—but Parliament should have an adviser and a watchdog so we can decide whether we continue to have trust in the Prime Minister and the Ministers he appoints. That is perfectly constitutional, and those who are trying to make out it is not are misguided. It might not be useful politically, it might be a distraction and it might be unnecessary if we improved the whole system—

Justin Madders: With a new Prime Minister.

Lloyd Russell-Moyle: Yes, if we had a new Prime Minister who obeyed the rules and if trust returned because people believed there is good behaviour, I could buy the political argument that Parliament having an adviser might be unnecessary, but we currently have a situation in which a Minister was sacked because of Islamophobia, a breach of the ministerial code. There is meant to be an investigation, but we are none the wiser. The Prime Minister is one of the main witnesses in that investigation, and he will determine how his own witness evidence is balanced against other witness evidence. Surely everyone can see there needs to be independence in the process.
The witness evidence should be balanced and released to the public, even if the Prime Minister still makes the final decision. Surely we can all agree that one of these stages should be made public. As much as people want to talk about the separation of powers, the separation of legislation, law enforcement and deliberation on whether the law has been broken is a fundamental principle of justice in this country.
We currently have a situation in which the Prime Minister writes the rules, the Prime Minister or his proxy starts the investigative process and the Prime Minister determines whether the rules have been broken. That is a fundamental breach of any sort of natural justice, and it is not fair on Ministers who are stitched up for technical breaches, not fundamental breaches, and are sacked for no good reason, while other Ministers who have done the same thing are not sacked because it is politically expedient. That is not fair or natural justice for Ministers, either. It does not protect them.
I am not saying the motion is a perfect solution, but there needs to be a process. Having a process in which a parliamentary Committee can make recommendations is not new. We currently have a system in which certain appointments made purely by the Prime Minister go through Select Committee appointment hearings. I sit on the Public Administration and Constitutional Affairs Committee, which is being offered the opportunity to have greater responsibility, and it already does that in a number of areas, and other Committees do it, too. Our recommendations can be ignored, but at least they are made in public. The motion would make no change to that constitutional provision, but it would make ministerial appointments and abidance by the code open and fair. The motion makes no change to that constitutional provision, but it would make ministerial appointments and abidance by the code open and fair. I do not think that it is unreasonable. I do not think that it is unreasonable  to support the motion, but more fundamentally, it is not constitutional and is only necessary because the Prime Minister has acted badly.

Several hon. Members: rose—

Rosie Winterton: Order. Just a gentle reminder that we still have quite a lot of speakers to get in before the wind-ups start, so below 10 minutes is best—as the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) did, after catching my eye.

John Penrose: It is a pleasure to follow such illustrious members of a series of Committees, all of which focus on this area and all of which have shown the importance and critical nature of the issue that the motion is trying to address—[Interruption.] I apologise, Madam Deputy Speaker, I will turn my phone off.
The debate also shows that there is a high degree of cross-party unanimity on the central importance of having somebody in the position of the independent adviser on the ministerial code. It is absolutely essential that everybody, from all parties, who has spoken so far has started from that fundamental principle. Everybody agrees with it. That was why I was delighted at what was said. I think we got there in the end, but I hope that when my right hon. and learned Friend the Minister winds up, with the leave of the House, he will take the opportunity to repeat his comment, which we prised out of him after a number of interventions: that he and the Government agree that a successor to Lord Geidt must be appointed, and must be appointed as promptly as possible. I think he wants a degree of flexibility about the process through which that happens and should the role be split, for example, between people so that we ended up with a panel or something like that. I think he wants the flexibility to allow those changes to be introduced, but the principle that there should be somebody or some group of people—

Michael Ellis: indicated assent.

John Penrose: Let the record show that the Minister is nodding vigorously. It is essential that we get on the record the principle that the role must be pursued and continued. I think that he has said that already, but I hope that he will take the opportunity to make that clear again in his concluding remarks. It is essential that that is clarified, because a number of us were expecting it to be made clear and I hope that we have heard it and will hear it being made clear again.
An awful lot of the concerns that led the motion to be tabled in the first place would be greatly allayed by such a clarification. People are worried, as there have been briefings in the press saying a successor to Lord Geidt might not be appointed at all, and that it might not be an important position to fill in future. I think that the Minister has already said, and I hope that he will repeat, that that is not true, it is not the way that the Government are thinking and that there will be successors appointed to make sure that that crucial role is filled. It is vital that it is filled, because it is independent, and because the independent reports are made public, it provides not  just the Prime Minister but everybody in this Chamber, more broadly in society as a whole and in the press with an independent set of facts on which to proceed, to say, “This happened, this did not; this is serious, that is not,” and from which we can all start our conversations, discussions and debates about essential items of probity, integrity and, ultimately, honesty from a shared base of fact.
I venture to make a suggestion to my right hon. and learned Friend the Minister as he goes around trying to find the successor to Lord Geidt. A number of people have said that that might not be terribly easy at the moment and I have a couple of gentle suggestions that might make it a simpler and easier succession. It might be easier for the Prime Minister to find successors if he were to upgrade the role further than the power enhancements that have already been made. I think he should consider two further enhancements of the role. The first is that the adviser or advisers, whatever format the thing takes—[Interruption.] Sorry, Madam Deputy Speaker. I definitely turned my phone off, but it keeps coming on.
The problem is that at the moment, the adviser believes that they must resign if their advice is not followed. I do not think that is the right approach at all—just take the case of Chris Whitty, who was advising the Prime Minister throughout the pandemic. If he had had to resign every single time his advice was not followed, he would have been resigning every week and we would not have got anywhere. Advisers advise; Ministers decide.

Jackie Doyle-Price: rose—

John Penrose: I will give way in a second.
This is an advisory post, and if the adviser’s advice is not followed, they may decide they want to resign if they are fed up, but they should not feel constitutionally required to do so. [Interruption.]

Rosie Winterton: Order. The hon. Gentleman needs to bring his remarks to a close, but we will take one intervention.

Jackie Doyle-Price: I hear what my hon. Friend is saying, but the difference is that ultimately, Chris Whitty’s advice was based on policy. What we are talking about here is behaviour, and whether there are breaches of the ministerial code. That brings the whole area of ethics into much sharper focus.

John Penrose: I take my hon. Friend’s point. All I am saying is that it should not be axiomatic and automatic that the adviser should feel they have to resign every time their advice is not followed. Their advice is made public and is clear, and therefore it should not be automatic that they have to stand down.
Equally—this is also crucial—Lord Geidt said that he did not feel he could offer an independent set of advice on the behaviour of the Prime Minister, alone among all Ministers. Lord Geidt would have felt able to, and did, offer advice independently to the Prime Minister about other Ministers’ behaviour, but he felt he could not do so when the Prime Minister’s behaviour was in question. That is clearly wrong: there should be no free  passes for any Minister, up to and including the Prime Minister, and in the same way that the adviser should not feel duty-bound to resign if their advice is not always followed, they should feel able to offer public advice on whether or not the Prime Minister has erred and strayed. If the adviser’s role is improved in those two ways, I believe that finding a successor to Lord Geidt will be a great deal easier, because the role will be a great deal clearer and more practical to fill.
I will just add one further point about the motion. It seems to me that it does not actually confer any extra powers on PACAC, and the Chairman of that Committee, my hon. Friend the Member for Hazel Grove (Mr Wragg), has already said that he is delighted and honoured to be offered these opportunities, but would politely decline them anyway. He does not want this set of powers, and is politely declining the offer that is being made. Because the motion does not offer any extra powers, it would be perfectly acceptable, constitutional, and within the rules of this House for PACAC itself to launch an inquiry into the ongoing discussions and investigations, should it wish to do so. If it felt the position was not being filled fast enough, it could fill that gap.

Lloyd Russell-Moyle: rose—

John Penrose: I will happily give way to a member of PACAC.

Lloyd Russell-Moyle: PACAC has requested a number of times that Sue Gray come in front of our Committee, and we have been declined that opportunity through being blocked by the Prime Minister and the Secretary of State. Is that not a problem of parliamentary scrutiny that this motion might help to prevent?

John Penrose: As I read the motion, it does not confer any fresh powers on the Committee, and therefore it would not solve the problem that the hon. Gentleman has rightly pointed out. There may be a broader question about whether some people can be compelled to come in front of Select Committees—not just PACAC, but others as well—but this motion does not solve that problem either and therefore, I am afraid, will not move the ball down the pitch at all.
None the less, Madam Deputy Speaker—with apologies for my phone misbehaving throughout—there is an essential point here that I think everybody agrees on. A successor to Lord Geidt must be appointed. I think we have heard that one will be appointed; I hope we will have that reconfirmed in words of one syllable, and while we can allow the Government a little bit of time to decide precisely how and in what form that successor will be appointed, it must be a proper replacement, ideally with the additional powers I have described.

David Linden: When the lawyers are out in force on the Government Benches—with all the references to learned and right hon. and learned Members—you can tell that the Government find themselves in a bit of a sticky situation. I have a degree of sympathy with the Paymaster General, who, if he is not the Minister for “Newsnight”, is definitely the Minister for crisis who has to make statements and answer urgent questions in the House.
We all know that the Prime Minister likes to compare himself to Churchill. On one of his recent holidays, he posed while painting in the exact same way as Winston Churchill. People can compare this Prime Minister to a number of things, but in style of government he is probably more like Lloyd George, who was arguably one of the most centralising Prime Ministers. Many people will be familiar with the garden suburb—these days, they call it the flat suburb, but at least the flat has much nicer wallpaper!
The garden suburb aroused particular hostility, even more so than the activity of Sir William Sutherland and undercover deals with the press and trafficking of titles and honours in return for contributions to Government or party funds. It is funny how history reinvents itself. Critics have also quoted Dunning’s famous resolution against Lord North’s Government in 1780 that the power of the Prime Minister was “increasing and ought to be diminished”. That gets to the heart of the debate, which is symptomatic of a wider presidentialisation of government. To be fair to the current British Government, this is not new—Tony Blair, for example, was keen on sofa government, and there is the idea that Cabinet government started to break down.
One reason why the House feels the need to step in and take control of the situation is that the current Prime Minister is like no one we have dealt with before. Most of us would accept that he has been described by his own colleagues as a bit of a slippery pig that can get out of situations. I do not doubt that, and I would not be surprised if the Prime Minister survives and leads the Conservatives into the next election. There is a great irony, which I will come back to at the end of my remarks, about our reliance on Tory MPs to remove him. This is a Prime Minister who has not played by the rules; perhaps learning from the effects of Tony Blair and Gordon Brown, he has tried to clip the wings even of the Treasury. The desire to centralise more and more power to No. 10 was the reason the right hon. Friend Member for Bromsgrove (Sajid Javid) stood down as Chancellor of the Exchequer, and it is something that the House should be mindful of.
The Tories would do well to support the motion. I see this as an issue not of tinkering with the constitution but fundamentally as one of House business. The motion delegates powers and tasks to a Select Committee of the House. I know very well the hon. Member for Hazel Grove (Mr Wragg) and had the privilege of serving on a Committee with him in my first Parliament. I will have no difficulty trusting the Public Administration and Constitutional Affairs Committee to fulfil these functions. In many respects, the hon. Member for Weston-super-Mare (John Penrose) is dancing on the head of a pin somewhat, because he knows fine well that the Minister has not given the undertaking that the Government will move—

John Penrose: I thought I heard it. The hon. Gentleman might not have heard it, but with any luck we will both hear clarification later.

David Linden: I respect the Paymaster General enormously but it will take a lot for him to reassure me about the Government’s role on ethics.
When I asked the Paymaster General earlier to define “in due course”, he was not able to say that the appointment would take place by the summer recess or the conference recess. We might—who knows—have a general election  in October. I would not be surprised if the Government ended up not appointing an adviser. As they have said before, they are tired of experts. I think they see the role of an adviser as a hindrance, particularly at a time when they will almost certainly have to break international law, albeit in a “very specific and limited way” as the Government like to do in their legislation.
I find some of the contributions I have listened to in this debate a little jarring, with people talking about accountability and respecting the importance of democracy. Let us not forget that this Government have increasingly taken recently to appointing people who are essentially failed election candidates to the House of Lords.
Look at someone such as Malcolm Offord, now Lord Offord, who is now a junior Minister in the anti-Scotland Office. He has given money to the Conservative party, he has not had to have the inconvenience of going through an election and was appointed as a junior Minister to the Scotland Office. Or there is Ian Duncan, a former Tory candidate against my hon. Friend the Member for Perth and North Perthshire (Pete Wishart). He could not beat my hon. Friend in an election, but he got into the House of Lords anyway. Zac Goldsmith, a friend of the Prime Minister and his wife, who failed in the last election to be elected to this House is in the House of Lords as a Department for Environment, Food and Rural Affairs Minister. When the Tories start to talk about accountability, we should be slightly aware of the context, because it is not a particularly good one.
I have one suggestion I want to pursue. The Government seem to think that the way out of this is talking about an office of the Prime Minister. That is a half-baked suggestion. I do not disagree with having an office of the Prime Minister, but if we are going to have one, they should have something akin to what they have in New Zealand. At the moment, the office of the Prime Minister is merely a rebuttal in a press release; it will create a new office with a new permanent secretary, but who will it be accountable to?
We in this place trust that the Prime Minister is accountable every now and again to the Liaison Committee, but we all know that the Liaison Committee, with the greatest of respect to my hon. Friend the Member for Perth and North Perthshire on the Front Bench and the hon. Member for Hazel Grove (Mr Wragg), is largely an opportunity for Select Committee Chairs to grandstand. If we are going to have an office of the Prime Minister, there must be a mechanism through which we can hold it to account. That is why I think the idea is half baked.

Alistair Carmichael: In terms of accountability, does the hon. Gentleman agree that where an allegation of impropriety is made against a Minister and is investigated, as a matter of principle the outcome of that investigation, whatever it is, should be published?

David Linden: In short, yes I do.
The final point I want to make is that, while in many respects this is a very noble motion before the House and I will happily vote for it tonight, there must be a realisation in this place that with the current holder of the office of Prime Minister, politics has changed enormously, and we as Members of the House of Commons are going to have to get used to that. This is a Prime Minister who has defied all the norms of politics, who has now outlived Trump and may go even further.
I ask Members of this House to remember who the current Prime Minister is. I know I cannot refer to him by name, but on issues of racism he wrote:
“It is said that the Queen has come to love the Commonwealth, partly because it supplies her with regular cheering crowds of flag-waving piccaninnies”.
In 2018, he compared Muslim women to “bank robbers” and “letter boxes” and said he would ask a person with a niqab to remove it before speaking to him. He wrote that single mothers were to blame for producing a generation of,
“ill-raised, ignorant, aggressive and illegitimate children”.
In 2002 he said in a book:
“If gay marriage was OK…I saw no reason in principle why a union should not be consecrated between three men, as well as two men, or indeed three men and a dog.”
The point is that this Government can have all the advisers on ethics they like, but I am fairly sure that if another one is appointed, they will have to resign again. The issue here is not necessarily the role of an adviser for ethics; the issue is that we have a Prime Minister who has no ethics.
We find ourselves in a remarkable situation where, as the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) just mentioned, a majority of people in this House do not have confidence in the Prime Minister. Remarkably, members of my party are told we cannot have a second referendum on independence, but for hon. Members on the Conservative Benches, the only opportunity they have to remove the Prime Minister is a second vote in a year’s time. That irony is lost on nobody.

Rosie Winterton: In order to give all the remaining speakers equal time, I need colleagues to stick to about seven minutes.

Jackie Doyle-Price: I shall endeavour to do so, Madam Deputy Speaker, but I have quite a lot to say on this, because I am so disappointed. The ministerial code really does matter, and it says everything about the leadership and culture of our style of Government that some of the responses to Lord Geidt’s resignation from some quarters of the Government have been rather disappointing. It is really important that everyone in public service abides by the rules of the game. That is what maintains respect and honour in all our institutions.
There are a few messages that I would like to land. The end does not justify the means, and, taking back control does not mean pleasing yourself, must be clear principles. Those two principles need to be looked at in the context of Lord Geidt’s resignation, because he has been clear that he was, in effect, being asked to give the Government a bye to wilfully break their international obligations under law. That is not acceptable, and, frankly, that should not be acceptable for any self-respecting Conservative Member of Parliament, because if there is one thing that we do believe in, it is constitutional propriety. It is about upholding the law, and that is central to the ministerial code. It is really important that we sustain that.
We are the Conservative party, the party of Margaret Thatcher and Churchill, not the party of Donald Trump. That is exactly what we are talking about. If such law breaches are sanctioned—even if there are the best of motives, such as to save our steel industry—I am afraid that sets a precedent for people to use law breaches for much more malevolent intentions. It should be in the DNA of Conservative Members, for whom constitutional propriety is so important, to ensure that we play by the rules of the game, however politically inconvenient, because there is always more than one route to achieve an outcome.
This is fundamentally not British behaviour. If there is one thing in the British DNA, it is a belief in fair play and upholding the rules. Our global reputation is built on our respect for the rule of law and how we have exported that around the world. It is incumbent on all of us to ensure that we uphold the most important standards.
I remind Conservative colleagues that also central to the British brand is belief in free trade, but Lord Geidt felt compelled to resign—he was being asked to turn a blind eye to waiving our obligations in respect of the WTO—on an issue that seems to be the complete antithesis of the ethos underlying why we left the European Union in the first place. The world expected us to be free traders, yet our actions fly in the face of that.
It is essential that the Government, in taking the matter forward, look at who should be the next ministerial adviser—although anybody would be taking a massive reputational risk in taking the job without being offered some very clear guarantees. Perhaps the biggest question mark facing our credibility in government right now is not about policy but about our behaviours. We have had two years of one story after another, with perhaps the most notorious being partygate, and that has led the public substantially to conclude—the jury were already out on us anyway—that we do not live in the real world and, “It is one rule for them and another for the rest of us”. We need to reboot public confidence by actually respecting our obligations under the law and maintaining that the ministerial code is important. Central to that is upholding the law.
My request to the Government is really to take stock. We have seen not just the recent resignation of Lord Geidt —actually, we have lost two advisers on ethics—but the Greensill scandal, which also raised issues about how the ministerial code applies to outgoing Ministers, who are still obliged to abide by it even though there is no sanction to deal with them. We have heard evidence in PACAC from Lord Pickles, as chair of the Advisory Committee on Business Appointments, that the volume of inquiries that he is getting is rather more than the small honorarium that his members are asked to deal with.
Essentially, we have got a regime that relies on everybody behaving appropriately. When everybody knows what represents good behaviour, and everybody is prepared to behave and to do the right thing, we can get by with a light-touch regulatory regime. The romantic in me thinks that we still can, but, day by day, that confidence is being diminished. I do not want to see any kind of statutory regulation of Ministers under the ministerial code, but if we are going to avoid that, it is incumbent on the Government to seize and recognise the difficulty   that our current standards regime is in. I ask the Government in all sincerity to properly reboot this and have a proper look at the ministerial code.
By way of illustration, when I became a Minister, the ministerial code was given to me as a flimsy photocopy at the bottom of my first box. No importance was set on it, yet the code should come from the top. We expect the principles of the code to be in the DNA of all our Ministers when they are delivering their obligations and undertaking their duties. This is not just a little bit of PR to say, “Aren’t we all doing terribly well?” This is fundamental to how we should operate our Government, and we need to really articulate that message and have a proper regime for overseeing that.
The Public Administration and Constitutional Affairs Committee will always be here, and we will still shine some light on those issues that we are not very happy about. In fact, we have probably spent more time looking at these things than we ever intended to, being rather more interested in constitutionally nerdy positions than in ferreting out scandals, but I would much prefer that we had far less material in that regard. Institutions such as PACAC and the Committee on Standards are still here. We do not need to go down the road of statutory regulation, but we do need the Prime Minister and all Government Ministers to recognise that the rule of law and upholding the law are not just optional extras; they are essential.

Jamie Stone: May I say at the outset that Lord Geidt is a personal friend of my family? I do not wish to go any further than that, other than to say that I should like, along with everyone else here, to express my thanks for all that he has done.
What is at stake here, as the hon. Member for Thurrock (Jackie Doyle-Price) admirably hinted, is the issue of trust, and I want to give an example of how this works in practice. My predecessor bar two was Robert Maclennan. Bob was first elected in 1966 with a majority of 64 votes. After that, as the elections went by, he increased his majority and stayed as the Member for Caithness and Sutherland and latterly for Caithness, Sutherland and Easter Ross until he retired. What is interesting about Bob’s career is that he changed party twice. He was elected as a Labour Member in 1966. He was then a founding member of the Social Democratic party and was one of the few SDP Members to hold his seat in 1983. He subsequently joined the Liberal Democrats, and that was what he was when he retired. That is most unusual for a politician, but the reason he held his seat was that he was trusted. He was known to be a man of integrity, decency, kindness and diligence. So, trust is crucial in what we are talking about this evening.
We describe ourselves with pride as the mother of Parliaments, but when I have talked to people in my constituency in the last few weeks, they have said, “Can you trust anything that is said in that place? How do you feel about it?” That saddens me greatly, because if we are to be the mother of Parliaments, and if we are to stand up for democracy across the world, we need to know that we do things absolutely by the book and with absolute integrity. If there is any hint that we do not, that damages the reputation of this place, and I regret  that massively. I find myself in agreement with the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), who is no longer in his place. He also came to the nub of the issue when he said that this is about trust and about being seen to do things properly.
If I were to find myself in deep trouble and in a court of law, I would have no hesitation in hiring the services of either the Minister or the hon. Member for South Leicestershire (Alberto Costa), because I am certain that those august gentlemen would provide me with a most eloquent defence and probably get me off. But we are being looked at by the general public, and the general public are not fools. They are more than capable of coming to conclusions about people. Is this person—he or she—telling the truth? Is this person to be trusted or not? Let me give the House one good Conservative example of somebody who I believe was trusted: John Major. He was seen to be a straight guy and a straight Prime Minister. So trust is there. What I say to the Minister for the Cabinet Office and Paymaster General is this: be careful. Be careful about clever arguments. Be careful about the use of words that can have all sorts of different meanings, because the British public has no time for that whatsoever.
I agree with other Members. I very much hope and expect that the Minister will clarify exactly what he means about the appointment of a new ethics adviser. That is essential. It sounds a bit apocalyptic but let me say it: I believe the nation is watching right now and at stake is the reputation of this place. If we take it seriously then it matters absolutely not just how we do things or how we are seen by our electorate or the country, but across the world. I await and I hope.

Justin Madders: The origins of this debate are more than six months old and lie in the farce that was the investigation into the refurbishment of the Downing Street flat. I call it a farce not because I want to undermine Lord Geidt—I cannot hold a candle to the Prime Minister in doing that—but because it is clear that he was led a merry dance by the Prime Minister in the first place, when the Prime Minister failed to disclose a series of crucial WhatsApp message between himself and Lord Brownlow.
The accidental omission of those messages in the “dog ate my homework” style that must have been forged in the gilded halls of Eton made sure that Lord Geidt was pretty embarrassed that he had been taken for a fool in that way. He said as much in the second letter he wrote to the Prime Minister about the investigation:
“It is plainly unsatisfactory that my earlier advice was unable to rely on the fullest possible disclosure of relevant information.”
That is a very polite way of putting it. The nub of it is when he wrote that
“this episode demonstrated insufficient regard or respect for the role of Independent Adviser.”
That was a very clear warning sign about where this was all heading. What did we get then? The Prime Minister, without a hint of irony, wrote back to Lord Geidt and said:
“I very much value your work as my Independent Adviser. The role is critical for the effective government of this country.”
That strikes me as quite a contrast to the position six months later.
It is still not entirely clear, despite what the Minister said, whether the Government believe an ethics adviser is necessary. Even worse, the Culture Secretary said this week that nobody gave “a fig” about him resigning. Well, I certainly disagree with that view most profoundly. Where I find more common ground with the Culture Secretary is when she said that Lord Geidt was always complaining that he had too much work to do. I can well believe that with this Government and this Prime Minister, anyone concerned with ethics would certainly have a heavy workload. Perhaps we need two ethics advisers in future. We find ourselves in a position where six months ago the ethics adviser effectively put the Government on notice that he was very unhappy with the way he was being treated.
Last month we had the annual report from Lord Geidt in which he states:
“It may be especially difficult to inspire that trust in the Ministerial Code if any Prime Minister, whose code it is, declines to refer to it. In the case of the Fixed Penalty Notice recently issued to and paid by the Prime Minister, a legitimate question has arisen as to whether those facts alone might have constituted a breach of the overarching duty within the Ministerial Code of complying with the law.”
There is a pattern here. As with the missing WhatsApp messages, anything inconvenient is ignored in the hope that it will eventually go away. But of course the Prime Minister could not ignore such a clear signal in the report. We need not have worried, because he wrote back to Lord Geidt and said he did not think he had broken the ministerial code and how silly it was for any of us to think that actually breaking the law might also be a breach of the ministerial code. All of us can see the benefits of being judge and jury, and why robust checks and balances need to be in place.
On the resignation letter, Lord Geidt said that an intention to breach the ministerial code deliberately in advance
“would be to suspend the provisions of the code to suit a political end”
and that would make a mockery of the code. I agree with him, but I think we reached the point of mockery of the code when the previous adviser resigned after his recommendations were also ignored. We cannot pretend that what Lord Geidt said there is anything other than a damning statement. For the Prime Minister’s own ethics adviser, appointed by the Prime Minister, to walk away after having his patience tested repeatedly, having warned repeatedly that trust was being eroded, is a state of affairs that should send a shiver down all our spines. Every single one of us in this place who is concerned about the probity of Government, who thinks that it is our job to uphold the law, not to break it, should see that statement as the ringing of the loudest of loud alarm bells.
The ethics adviser is not there to provide cover for the Prime Minister who wants to bend the rules. The ethics adviser is not there to be ignored when the advice proves inconvenient, and the ethics adviser is not there to be made a fool of. They are there as a safeguard for the wider responsibility, which we all have, for the way that politics is done. None of us is here for ever, but while we are here, we need to remember that we are the guardians   of democracy. What we say and where we set the limits of adherence to the rules while we are here matter because they become the starting point for the next generation to work from.
If we do end up in a position where the Government of the day decide that an ethics adviser is no longer needed, or we never get to a point where one is appointed, even though, six months ago, it was said to be a critical position, where does the conversation go after that—to a further erosion of the safeguards that any mature democracy needs? Let us be clear: we do need those safeguards, because democracy is fragile and it cannot be taken for granted; it has to be cherished and defended by us as its guardians. Every watering down of the rules, every reduction in transparency, every erosion of accountability have to be fought against because many Governments want—to coin a phrase—to take back control. Most Governments, however, also have a respect for the rules, understand their place in history and know that having clear rules to which everyone is accountable is the glue that holds our democracy together.
When we have a Government with a track record like this one, it really is up to us to push back against that. Whether it be breaking the law in a specific and limited way, trying to wriggle out of treaties signed, changing the way that the standard rules operate, or excusing breaches of the “Ministerial Code”, this Government have shown, time and again, that they do not think that they need to abide by the rules. However, rules do matter. The rules about how our politics is conducted should be there long after we have all gone and they should not be jettisoned because it is convenient for the Government of the day to do so.
Parliament should be the beacon of fair play. It should be an example for others, both in this country and abroad, to look at and say that, yes, democracy is a good thing, and that it can change people’s lives for the better. Not all politicians are self-serving, but when we see a bending of the rules, the ignoring of them, or the changing of them to suit a short-term political agenda, those looking in on this place can rightly say, “Who are you to lecture us about responsibility? Who are you to tell us about showing leadership?”
Leadership is what this is all about. Those at the top need to behave with honour, to respect conventions and to recognise their wider responsibility to the body politic. That is all put at risk when those in power do not see the importance of that, and the weaknesses in our unwritten constitution become all too apparent. That is when our democracy is diluted, and with a Government who, because of the size of their majority, grow contemptuous of the need for probity and bit by bit dismantle the safeguards that we need, we enter this dystopian world where newspaper stories mysteriously disappear and the Prime Minister tells the world that no rules were broken when they clearly were.
This motion tonight will not reverse the dark path down which we are already heading, but it will slow it a little, and with persistence and, dare I say it, a little more courage from the Conservative Benches, we might begin to reverse it. We owe it to ourselves and to the democratic ideals in which we must all at one time have believed to do just that.

Geraint Davies: Two ethics advisers gone, two months gone—and all the Paymaster General can offer us is a review. No one needs an ethics adviser more than the current Prime Minister. I studied maths, philosophy and economics at university and am therefore intrigued by how many times the Prime Minister is economical with the truth. Ethics is about right and wrong. It is about truth and falsehood. We heard in partygate about a Prime Minister who made the rules and broke the rules. He said that he did not understand the rules and that he did not know how they applied. We do not know whether he was guilty, innocent or drunk.
The situation is that we simply cannot trust the Prime Minister. That is the view of the great majority of MPs. Only 211 Tories voted with confidence in him, so more than two thirds of the nation’s MPs have no confidence in the current Prime Minister for what he has done.
Talking of ethics and philosophy, Kant’s categorical imperative—I know Members will be thinking of this—states
“act only in accordance with that maxim through which you can… will that it become a universal law.”
In other words, if you are going to have a party, everyone should party, and if they should not, you should not. It is not that complicated. According to Aristotle,
“We are what we repeatedly do.”
So what does that make the Prime Minister? At virtually every Prime Minister’s Question Time, he gets up and says that there are half a million more people in jobs than there were before the pandemic—although the Office for National Statistics says that there are 512,000 fewer people in jobs—because he inadvertently forgets to include the self-employed. Was that, in fact, an inadvertent mistake, or was it a piece of choreographed rhetoric to lead people up the garden path? There is a long list of things of this kind which undermine our democracy, this place, and politics in Britain.
Of course, ethics is about outcomes as well. People say, “Haven’t we done well on covid?”, but 170,000 people are dead thanks to the policies here, which led to the highest death rate in Europe. People say that the economy is all right, although ours was the worst recovery in the G7, and about 8 million people are hungry and in food insecurity. There is not really any accountability, other than the democratic process. We have just seen the Government provoke an unnecessary rail strike by demanding cuts in wages and jobs. There are alternatives to this. Germany, for instance, is saying that it will give everyone a public transport ticket for a month for €9 to boost the economy and jobs, rather than picking fights.
We have parliamentary privilege here, which means that there are limitations on what the courts can do when we breach the rules. The dampening and watering down of the rules here is therefore problematic, as is, of course, the attack on the judiciary itself. The all-party parliamentary group for democracy and the constitution published a report commissioned by the Rowntree Foundation and prepared by the Institute for Constitutional and Democratic Research. We found that there had been a sustained attack on the courts by Ministers through the media. That is undermining and chilling even the Supreme Court, which has reversed seven of its  decisions in the last two years. This was, of course, getting back at the judges, because they had made various decisions about giving us the right to vote on the Brexit deal. They made the Prime Minister return when he tried to abandon democracy.
What we are seeing is the weakening of internal laws governing the behaviour of politicians here, and, at the same time, an attack on the courts themselves. Meanwhile, there is an attack on international law. The withdrawal from the Northern Ireland protocol undermines our reputation abroad: it means that people such as the Americans do not want to have trade agreements with us. There is an attack on our democratic values and rights, such as the right to peaceful protest. There is an attack on human rights, as we are seeing in Rwanda, and an attempt to pick a fight with the European Court of Human Rights itself, a forerunner to withdrawal from the European convention on human rights—which, of course, was set up by Winston Churchill.
In the round, what we are seeing is a Prime Minister corroding and eroding the rules that govern our behaviour and our ethics, alongside an attempt to disengage from controls that may be applied and to which all countries and all people elsewhere are subject. So we cannot be trusted. “Values” of this sort feed into the hands of people such as Putin, who hate the democracy, human rights and rule of law that we are now undermining.
Lord Geidt has said that the Prime Minister has made a mockery of the ministerial code. He has said that we have broken international laws in the form of World Trade Organisation rules. We urgently need a replacement. No doubt some people will suggest that Lord Ashcroft might be the person whom we need. After all, he revealed David Cameron’s relationship with a pig, did he not, and indeed revealed the current Prime Minister’s relationship with the lover whom he offered a £100,000 job. [Laughter.] People may find these things funny, but they are of course true.
We do need to uphold higher standards here, and, in particular, the Prime Minister should and does not. It is imperative that we get a replacement, and it is imperative that in the interim, at least, we introduce some sort of system. That is what this motion aims to do, and I fully support it.

Rosie Winterton: I call the shadow Minister, Fleur Anderson.

Fleur Anderson: This could have been a very quick debate. The Paymaster General could have stood up at the beginning and just given us a date for when it would all happen—when the adviser would be reappointed, with a lovely timetable attached—and we would all have been happy and could have left it at that. However, I am now, to be honest, more concerned about what is going to happen than I was at the beginning of the debate.
Labour has called this very important debate today because the whole of our ministerial standards system is unravelling before our eyes. Corruption does not arrive in any country unannounced or with a big bang; it creeps and corrodes, and honour and trust, once lost, are very hard to win back. That is what is at the heart of this debate. This Labour motion would put the Government into special measures and ensure that the ethics adviser  is recruited as soon as possible and the post is not ditched. We are concerned about the Paymaster General’s comments about pausing and reflecting, and about having a review instead of appointing. We want to know that a very clear decision will be made about this adviser position, because otherwise ethics and integrity will slip away.
The Prime Minister is leading the way in being unethical and breaking the rules, and that is why the person whose role it is to hold Ministers to account, to investigate breaches and to stop the rot felt that he had no choice but to resign. The motion calls for urgent action to appoint an ethics adviser because otherwise, quite simply, we do not trust the Government to appoint at speed. We do not trust what Ministers will do without this oversight. We have heard that a review will be conducted before the appointment “in due course”. That is very concerning. We know that for this Government it is one rule for them and another for us.
I thank all Members for their excellent contributions, including agreement on both sides of the House that we need this urgent appointment. My hon. Friend the Member for Bristol South (Karin Smyth), who is a member of PACAC, the Committee focused very much on today, outlined the evidence given to it by Lord Geidt on issues from wallpaper to the Northern Ireland protocol to leaks by Ministers under investigation, and the need to bring decency back into our politics. My hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle), also a member of PACAC, said that it is quite simple: the Prime Minister has lost the trust of the people and of his own MPs as well. He highlighted the circularity of the process by which the Prime Minister appoints the adviser, and then has to look into evidence given by himself about himself and to be the judge of it. The system does not work; it needs to change.
My hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) talked about how difficult Lord Geidt’s position has been and the fact that he said six months ago that there had been insufficient respect for the role of the adviser. Then there were the fixed penalty notice warnings from the adviser, setting alarm bells ringing, as is still the case, that bit by bit probity is being ignored and it is a dark path we are heading down. That is the dark path we want to stop with our motion today. My hon. Friend the Member for Swansea West (Geraint Davies) pointed out that Aristotle said:
“We are what we repeatedly do.”
He talked about the Prime Minister’s corroding of our rules and ethics, the weakening of internal laws, and the attack on international law as well.
We have a cost of living crisis. My constituents and the British public are worried about how they are going to pay the bills, feed their children and get to work. They have to know that Government Ministers are acting in the public’s best interests and not in their own interests. They have to know that Government Ministers are not acting in the interests of their families or friends, or party donors, or pub landlords, or their own wives. They have to know that they are acting with impartiality, with no fear or favour.
I realise that the position of the independent adviser will not be an easy position to recruit for, as many hon. Members have said. It will be a tough job description to  put together and a tough job advert to write. Last time it took five months to appoint a replacement ethics adviser, and now Downing Street has been hinting at not reappointing one at all. That is why we have tabled the motion today. The outcome of the review could be not to appoint and that will be unacceptable.
Labour’s motion puts an essential backstop in place, so that if the Prime Minister cannot get his act together in two months’ time, the cross-party Public Administration and Constitutional Affairs Committee will appoint that adviser. That adviser will be given the powers and information that they need to investigate potential breaches of the code by Ministers, and that adviser will report to the Committee, so that there is transparency, honesty and integrity.
Without anyone in post, with the ethical vacuum that we currently have, there will be no one for Ministers to give their full list of interests to that may be thought to give rise to a conflict. There will be no one to investigate possible breaches of the ministerial code—and there could be many. There will be no one to advise the Prime Minister on the code, which is particularly worrying, given the Prime Minister’s seeming lack of literacy in the code, and no one to complete investigations that have been started, such as the allegations of Islamophobia by the hon. Member for Wealden (Ms Ghani).
Senior civil servants are also worried. Dave Penman, general secretary of the FDA, the senior civil servants’ union, said,
“confidence in the process has been severely damaged. If the prime minister does not intend to replace Lord Geidt, then he must immediately put in place measures to ensure a civil servant can, with confidence, raise a complaint about ministerial misconduct.”
We cannot just leave a vacuum at the top—it is far too worrying.
Labour would introduce a stronger standards system. We would appoint at speed, but we would go further. We have called for the expansion of the scope of the statutory register of lobbyists, a ban on MPs taking up lobbying jobs for five years after leaving office, and the establishment of an independent integrity and ethics commission with actual powers, not in hock to the Prime Minister.
The Secretary of State for Digital, Culture, Media and Sport said that voters “don’t give a fig”. They do give a fig. A recent poll showed that 74% of the public think that the Prime Minister is untrustworthy. That is up by 30% in the past two years. Another survey, conducted on the day Lord Geidt resigned, found that nearly 70% of the public believe that the Prime Minister behaves in an unethical way, with 46% thinking he behaves “very unethically”. This is unacceptable. I would counsel the Minister and his colleagues not to insult the British electorate. They do give a fig about honesty; they do give a fig about integrity.
I want to end by asking several hugely important questions that the Minister failed to answer in his opening speech, but I am sure he will come to now. First, can he confirm whether ongoing investigations launched by Lord Geidt will now be completed? Can he confirm whether there would be an interim position or role holder for the ethics adviser if the recruitment process is not completed within two months? When will the replacement be appointed? Can the Minister assure us that there will not be another five-month gap? When is  “due course”? Is it September or October? Is it Christmas? Is it next year? And who is holding Ministers to account in the interim? “Wait and see” is not an acceptable answer. With no ethics adviser in place and no obvious backstop, Ministers are free to do as they please without consequence. It is a blank cheque for bad behaviour. While the cat’s away, the mice will play. This may be an attractive position for the Government, who have always found the rules to be incredibly inconvenient, but it is not attractive and not acceptable to the British public.
I commend the motion to the House.

Michael Ellis: With the leave of the House, I would like to close this debate.
As set out by the right hon. Member for Ashton-under-Lyne (Angela Rayner) in her opening remarks, and for the reasons I explained to the House in my opening remarks, the Government will not be supporting the motion. The Labour party has called the debate to throw mud, but I would caution that those who throw mud often find that some of it sticks to themselves. I would also caution and place on record that the Government remain absolutely steadfast in their commitment to upholding the standards in public life that we all respect, to the critical role that the ministerial code plays in standards in public life and to supporting those standards. On account of that commitment, the Government cannot support today’s motion, which would, counterintuitively perhaps, by proxy, weaken the ministerial code. As I said earlier, it would at the same time change the British constitution by the back door, without consultation and without consideration.
On the appointment of a new adviser, can I answer with this word: yes. The Prime Minister intends to appoint a new ethics adviser and we will announce how that is to be done and who is to do it in due course. But it does have to be done properly and in a way that will ensure that Parliament and the public have confidence in it. I think that I may be asked what “in due course” or “in good time” means. It means doing it right, and getting the right people to come forward, to be interviewed and to go through the process. It means actually getting it right, not just responding to the latest headline. It means making a process that might actually work in the longer term.

David Linden: Will the Minister give way?

Michael Ellis: I will give way to the hon. Gentleman, but he knows exactly what is meant by this.

David Linden: I am very grateful to the Paymaster General for putting on record that the Government do intend to appoint an adviser, but can I just push him a little further and ask him to say whether that appointment will take place before, say, the conference recess?

Michael Ellis: The answer is a very simple one: the process will be done properly. It will be done in a way that will give confidence to the system; it will be done in a way that the House, Ministers and everyone concerned will be confident in. So it is not possible to give a particular date for it. After all, it is only a matter of days since this situation came about. What is meant is clear: we are still considering this carefully, and we  remain fully committed to making sure that all Ministers, including the Prime Minister, whose code it is, are held to account for maintaining high standards of behaviour and behaving in a way that upholds the highest standards of propriety, as the public rightly expect.

Karin Smyth: I think that what the Minister is trying to say is that what has gone wrong is either the process of appointing the last two advisers, or indeed the last two advisers—both of which seem to me to be dishonourable things to say, if I may say so—rather than the fact that both have resigned because of the behaviour, as they have admitted, of a Minister and the Prime Minister.

Rosie Winterton: Order. I do not think the hon. Lady was implying that something dishonourable had been said. If she was, I would want her to withdraw that.

Karin Smyth: I withdraw it.

Michael Ellis: I think the hon. Lady misunderstands the position, which I have made perfectly clear and will repeat. This is about getting the process henceforth right—a process that will have the confidence of this House, the Prime Minister, Ministers and everyone else. It is right to consider these things carefully and take time to reflect on them before taking a decision on how best to fulfil the Prime Minister’s commitment. It is the Prime Minister who has made a commitment to ensuring rigorous oversight and close scrutiny of ministerial interests. As I have said, we are looking at the best way to carry out this function, given some of the issues raised recently and set out in our plans. But I could not be clearer when I have given the single-word answer “yes” on the Prime Minister’s intention to appoint a new ethics adviser. We will announce how that will be done and who is to do it in due course. We will make sure it is done properly to ensure that Parliament and the public have confidence.
In the meantime, the Labour party, when its rail strike is in progress, has chosen today of all days to discuss this matter. I suppose half its Members are on the picket lines at the moment, blocking hard-working people from going about their daily business. They debate this matter for the umpteenth time and the umpteenth hour—so much so that my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner) says that she sees more of me than of her friends. The feeling is mutual, although I think she has far more friends than me, except on the Government Benches, where I have a lot more friends, of course, because the Prime Minister wins elections. He does not talk about personalities; he talks about policies. On policies, this party and this Government win.

Alistair Carmichael: I am grateful to the Minister for giving way eventually. I am sure that we all share his aspiration to have a process in future that commands public confidence, but he has not yet mentioned what it was about the previous system that did not command public confidence. What was it?

Michael Ellis: I will leave that to the right hon. Gentleman’s already active imagination, but I would say that not everything is a conspiracy. He should bear in mind the responsibility that he and his party have for  ensuring that this country’s railway system is working correctly and is not subject to industrial action. Why not support the people of this country in doing that? The red herring that he focuses on is symptomatic of where we are with this debate.
I have made it clear that Labour’s motion seeks to confuse the constitutional position of this country; it confuses the powers of the Executive with those of the legislature. We propose to move on and appoint an ethics adviser, as I have said. We will ensure that an announcement is made as to how it will be done and who will do it in due course, but I emphasise that it must be done properly. In the meantime, I respectfully caution the Opposition to get their Members off the picket lines and to support the people of this country, which is what this Conservative Government will continue to do.
Question put.

The House divided: Ayes 161, Noes 252.
Question accordingly negatived.

Business without Debate

Delegated LegislatioN

Rosie Winterton: With the leave of the House, we shall take motions 2 and 3 together.
Motion made, and Question put forthwith (Standing Order No. 118(6)),

Local Government

That the draft Local Government (Exclusion of Non-commercial Considerations) (England) Order 2022, which was laid before this House on 25 May, be approved.

Energy

That the draft Smoke and Carbon Monoxide Alarm (Amendment) Regulations 2022, which were laid before this House on 11 May, be approved.—(Marcus Jones.)
Question agreed to.

Committees

Rosie Winterton: With the leave of the House, we will take motions 4 and 5 together.
Ordered,

Levelling Up, Housing and Communities Committee

That Matt Vickers be discharged from the Levelling Up, Housing and Communities Committee and Sara Britcliffe be added.

Petitions Committee

That Katherine Fletcher be discharged from the Petitions Committee and Scott Benton be added.—(Sir Bill Wiggin, on behalf of the Committee of Selection.)

Petition

Petition - Universal Credit Deductions

David Linden: Many of my constituents in the Carmyle area have been in touch to raise awareness of research from the Child Poverty Action Group that shows that approximately 5,000 households in the constituency claiming universal credit are receiving on average £58 less each month. That affects 4,400 children in Glasgow East, including in Carmyle.
The petition states:
The petitioners therefore request that the House of Commons urge the Government to reduce Universal Credit deductions and allow families to access more of their Universal Credit award.
Following is the full text of the petition:
[The petition of residents of the constituency of Glasgow East,
Notes that analysis by CPAG shows that in the constituency of Glasgow East there are approximately 5,000 households claiming Universal Credit who are receiving on average £58 less each month than they are entitled to because of automatic deductions; declares that these deductions affect an estimated 4,400 children; further that immediate changes to universal credit deductions must be made in order to allow families to access more of their universal credit award, which will in turn ease the pressures of the cost of living crisis on struggling families; further that having to repay a universal credit advance which sustains claimants through the five week wait for the first universal credit payment, is the most common reason for a deduction; further that every month, families across the east end of Glasgow lose a total of £153,000 from their UC payments to service advance debts to the DWP; further that a further £31,238 is paid by UC claimants to HMRC for historic tax credit overpayments; further that the British Government should reduce the maximum deduction rate for government debts to 5 per cent of the UC standard allowance, in line with other creditors; further that the British Government should also reduce the cumulative level of deductions taken from peoples’ benefits from the current 25 per cent down to 15 per cent, and further that this cost-neutral intervention would provide up to £53 more a month for a couple and up to £33 more a month for a single person or lone parent.
The petitioners therefore request that the House of Commons urge the Government to reduce Universal Credit deductions and allow families to access more of their Universal Credit award.
And the petitioners remain, etc.]
[P002738]

Battersea Funfair Disaster:  Child Trauma Support Services

Motion made, and Question proposed, That this House do now adjourn.—(Miss Dines.)

Marsha de Cordova: This year is the 50th anniversary of the Battersea funfair disaster. I want to start by remembering the victims, their families, and the survivors. I also want to pay tribute to and thank two of the survivors, Hilary Wynter and Liz Haigh-Reeve, for their tireless campaigning to have the tragedy recognised and remembered.
The Big Dipper rollercoaster was the main attraction of the Battersea Park funfair which opened as part of the festival of Britain. Tragically, on 30 May 1972, a carriage of the rollercoaster broke loose and plummeted backwards through a barrier killing five children—Alison Comerford, Thomas Harmer, Shirley Nash, Debora Robertson and David Sait—and leaving 13 injured. The disaster is one of the deadliest rollercoaster crashes in history. However, it has largely been forgotten and there has been no justice for the victims, their families and the survivors.
To mark the anniversary of the disaster, I attended a special memorial ceremony together with families and survivors in Battersea Park where a plaque was unveiled and a tree was planted. That is the first step to creating a new legacy and a permanent memorial.
There is another silent tragedy associated with the incident, on which I will focus the rest of my speech. It is something that I am determined to change. Survivors have spoken about the devastating impact that childhood mental trauma has had on their lives. As one told me,
“bones are mended, physical injuries fixed, but the dreadful damage to our mental health goes untreated.”
Damage from trauma is not necessarily skin deep: some wounds penetrate through to our minds, leaving lasting damage that can be just as debilitating. Although the funfair and the big dipper are long gone, some of the survivors of the disaster still struggle to go to Battersea Park, and have been unable to shake off their horrific memories of that incident. I am sure many survivors of other tragedies, such as Hillsborough, the Manchester Arena terrorist attack and the Grenfell Tower fire, have been through similar experiences.

Jim Shannon: I commend the hon. Lady on securing this debate on childhood trauma support services. I would mention helpfully to her, and probably to the Minister as well, that we in Northern Ireland have faced 30 years of a terrorism campaign during which many young children, women and men have lost their lives. Such trauma can last way beyond the time that it happened. Does the hon. Lady agree that some discussions with the responsible Minister in Northern Ireland might be helpful when it comes to devising a policy and a strategy to address trauma and child mental issues, which I know she wishes to see?

Marsha de Cordova: The hon. Gentleman is right: we can all learn, and it would be useful for the Minister to say whether she would like to meet Ministers in Northern Ireland to look at what works well.
Childhood trauma can have a lifelong effect, and can have lasting consequences for a child or young person’s development, including psychological, behavioural and emotional problems. Those problems can occur into and throughout adulthood, presenting related challenges in many aspects of that person’s life. According to the UK Trauma Council, childhood trauma refers to the ways in which some events and experiences are so extreme that they overwhelm a child’s ability to cope. Many different experiences can lead to such trauma: for example, physical or sexual abuse can be traumatic for children. One-time events like the tragedies I have mentioned can take a psychological toll on children as well. Ongoing stress such as the effects of the pandemic can also be traumatic for a child, even if it just feels like everyday life to an adult.
We know that the pandemic has had a huge negative impact on children and young people’s mental health and wellbeing. The Children’s Commissioner’s Big Ask survey found that one in five children was not happy with their mental health, and that figure rose to two in five for some groups. Childhood trauma does not have to involve experiences that are directly related to the child: for instance, watching a loved one endure major issues can be extremely traumatic, as has been highlighted by the impact of the cost of living crisis on children’s mental health. According to the Childhood Trust’s latest report, 47% of children surveyed felt stressed, 21% of parents said that their children smiled less, and most concerningly, 9% of parents claimed that their children had started self-harming. The results of that report should worry us all, as all those types of trauma will affect children’s development and wellbeing.
The Government need to invest in mental health services to ensure that children who experience trauma today do not face the same painful ordeal that survivors of the Battersea funfair disaster have gone through over the past 50 years. Spending on children’s mental health remains behind investment in adult mental health services. It is worrying that children and young people’s mental health services are among the most under-resourced and that the quality of care varies between different parts of the country. A BBC freedom of information request revealed that 20% of children are waiting more than 12 weeks to be seen for mental health support. That is why I was pleased to secure this debate on better provisions for children’s mental health services and childhood trauma.
The Government need to correct the historical underinvestment in children and young people’s mental health and the postcode lottery of services and support provision. To do that, they must create a comprehensive child mental health strategy, and childhood trauma services must be prioritised as part of that. The UK Trauma Council has called for the Government to invest in the development and delivery of specialist trauma provision so that children and young people have access to the support that they need. It also called on the Government to equip all professionals who work with children and young people with the skills and capacity to support those who have experienced trauma.
Labour has already set out its plan on tackling the mental health crisis, which includes giving adequate funding to mental health services. We have also committed to radically expanding the mental health workforce, including, crucially, investment in children’s mental health  that includes putting open-access mental health hubs for children and young people in every community and ensuring that a full-time mental health professional is in every secondary school and a part-time professional is in every primary school.
Labour’s focus on early intervention is so important, because it can prevent the ongoing effects of trauma into adulthood. It would ensure that children are properly supported and resolve problems before they escalate. I will therefore ask the Minister about the Government’s plan for children’s mental health services and, specifically, childhood trauma care. When will her Government introduce a comprehensive child mental health strategy that includes prioritising trauma and investment in the development and delivery of evidence-based trauma service provision? How are they ensuring that children’s mental health services are a high priority in the NHS? That includes increased investment.
The Government have made £139 million available to support children and young people’s mental health in the community, but we need to see more investment. How are the Government working with professionals in contact points including in schools and the third sector so that children can access support when problems emerge?
Much work also needs be done to ensure that every child and young person gets the support that they need for their mental health and wellbeing. We need to step up as a society and be more ambitious in our call for better support for children and young people’s mental health. More funding and resources will be an investment in our children’s future. It is time for the Government to act and listen to the voices of children and young people, especially those suffering from trauma. If we do not act now, when will we?

Gillian Keegan: I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing the debate. I must admit that I was not aware of the tragic events that unfolded 50 years ago, on 30 May 1972, and I am sure that others were not, either, so it is fantastic that she secured the debate to remind us all. However, I discussed it with my husband when I got home last night. At the time, he was a 10-year-old boy growing up in London. He was very much aware of what happened and he vividly remembers it. What should have been a happy day in Battersea Park, on the bank of the River Thames, resulted in five children losing their lives and a further 13 being injured, and it shocked many more. I very much hope that the survivors’ campaign for a permanent memorial in Battersea Park is ultimately successful, so that that terrible event is never forgotten—maybe that is the plaque the hon. Lady referred to, or maybe there is something else that they are still campaigning for.
Undoubtedly, many affected by the Battersea funfair disaster will have suffered from what we now call post-traumatic stress disorder, but let us not forget that PTSD was not even added to the International Classification of Diseases until the ’80s, and guidance from the National Institute for Health and Care Excellence was not published until 2005. Events have taught us that people affected by any traumatic incident must be able to access timely mental health support when and if needed, but I am  not sure there was the same understanding all those years ago.
Luckily, PTSD can be successfully treated even when it develops many years after a traumatic event. The treatment depends on the severity of symptoms and how soon they occur after the traumatic event. The hon. Lady reports that survivors of the tragedy remain concerned that mental health support for children who have suffered trauma has not changed much since 1972. I too would be very concerned if that was the case, but I must respectfully disagree with that assessment.
If a child has witnessed or experienced a traumatic event, it is quite natural for them to be stressed, upset or frightened. That should not usually last beyond four weeks, but if it does, it may indicate post-traumatic stress disorder and it is then important to seek help via their GP. There are now some really effective treatments, including cognitive behavioural therapy, for children and young people who are experiencing the effects of trauma.
To respond to the hon. Lady’s specific question, NHS England and NHS Improvement have issued guidance on responding to the needs of people affected by incidents and emergencies, which stresses that plans for incidents and emergencies must provide psychosocial and mental health care for people affected, since early intervention for people at risk of developing mental health problems may reduce their severity and chronicity and, ultimately, related costs.
In general, psychological support can be accessed four to six weeks after the event for those who are exhibiting signs of needing professional help, as per NICE guidelines. Those who require urgent support may be referred to services sooner than that, and it is important to ensure that messaging about support services is appropriate. Not all people need psychological support, and many recover over the course of time without specific interventions, but it is still important that such people continue to look after their health and wellbeing after a traumatic incident. That includes getting enough rest, eating well, returning to their routine and staying connected with others.

Marsha de Cordova: I just want to ask about the support that is available via NHS England and ensuring that it is available, as the Minister says, within a four to six week period. Can she assure me that that is actually happening? Is there any evidence base to ensure that children who experience trauma or post-traumatic stress disorder are getting that support in a timely fashion?

Gillian Keegan: Yes, and of course we always try to ensure that, as the targets we put in are worked throughout the system, those targets are met. That is why we measure those things. Maybe it would be helpful to the hon. Lady if I gave some recent examples. In the wake of the Manchester Arena terrorist attack, which sadly affected many children and young people, the Greater Manchester Resilience Hub was set up to provide a central point for mental health advice for those directly affected, including children and emergency responders. The hub worked with other agencies to develop packages of care.
In response to the tragic fire at Grenfell Tower, more than £10 million has been spent on treating the mental health of those affected. In the year after the fire, 2,674 adults and 463 children were screened for symptoms of  post-traumatic stress disorder, and the St Charles Centre for Health and Wellbeing was opened up so that those affected could be treated in dedicated therapy suites. I hope the hon. Lady will recognise that we have seen a dramatic change in both attitudes towards mental health since the days of the Battersea disaster, and the NHS services available to support people with their mental health.

Jim Shannon: I am very encouraged by what the Minister has just said. In my intervention on the hon. Member for Battersea (Marsha De Cordova) I suggested some contact with the authorities in Northern Ireland, which unfortunately have a long 30 years’ experience of trauma, especially among children. Has that happened?

Gillian Keegan: I have not met my counterpart in Northern Ireland but, having heard the hon. Gentleman’s intervention, I sent a WhatsApp message to request that a meeting be set up, because it is probably long overdue. We can learn a lot from each other, and I am always keen to learn from anyone I can.
Over the past 50 years, we have seen the transformation of NHS mental health services for children and young people. From the passing of the Mental Health Act 1983 and the establishment of mental health trusts to more recent developments including the Time to Change campaign, which between 2007 and 2021 helped to improve the attitudes and behaviours of some 5.4 million people towards those living with mental health problems, these are all important steps along the way towards destigmatising mental health.
The publication of the five-year forward view for mental health in 2016 made the case for transforming mental healthcare in England. The implementation of the “Transforming children and young people’s mental health provision” Green Paper from December 2017 has seen the introduction of senior mental health leads and mental health support teams in schools and colleges. We regularly talk about that programme, and I am sure it will make a massive difference to young people, particularly those affected by the pandemic. The 2019 NHS long-term plan commits to expanding and transforming mental health services in England so that an additional 345,000 children and young people will be able to access NHS-funded specialist mental health treatment by 2023-24.
We are continuing to build up those services and the staff, as in some cases demand outstrips supply. As part of this work, we have all-age 24/7 urgent mental health helplines in all areas of England so that people experiencing a mental health crisis, or those worried about someone experiencing such a crisis, can speak to a trained professional. The helplines were established during the pandemic, so they are a relatively new addition to the landscape, but I am sure they are very welcome because many people have sought these services.
We are also accelerating the coverage of mental health support teams in schools and colleges from the 287 currently in place to over 500, covering around 35% of pupils by 2023-24. There are currently 16 mental health support teams operating in or planned for south-west London, so they have already started to roll out.
Our hard-working NHS community mental health services treated over 420,000 children and young people in 2020-21, an increase of around 95,000 on the previous year, so we can see there has been a massive increase  in demand for these services, which is why we are working very hard to try to build up the mental health workforce.
Although none of us wishes to see a repeat of the events in Battersea Park and the many things that have happened since, not only in mental health but in safety, I assure hon. Members that the NHS will always be there to support the survivors of such tragedies. However, it is important that we never forget. I am therefore  grateful to the hon. Member for Battersea for securing this debate and for making us all aware of something that happened. This issue is important to her constituents, and this debate will ensure that we all remember the tragedy and learn from the events of that day.
Question put and agreed to.
House adjourned.